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APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: Permit No: __ --------- __.-_----- ------ (Complete in Triplicate) rf� --- - Date Issued -------------- ----• - ----------------------- -------- This Permit Expires 1 Year From Date slue Count Ordinance No. 549 and existing Rules and Regulations: lication is hereby made to the San Joaquin LocalHealth District for a permit to construct and install the warherein: t decribed. This application is made in compliance yy,�� CENSUS TRACT ..S.y_�--- `' JOB ADDRESS/LO TIO - - e r - - Owner's Name �=--------- a r f -/ City - - - - Address # - .I - Phone SLicense Contractor's Name ----- - Installation will serve: Residence [E:] Apar tment�House'❑ Commercial❑Trailer Court •❑ Motel Other � bage Grinder _---.-_ ---- Lot Size _"----------- ---- --- --- Number of living units:---J----- Number of bedrooms ---.-.__ -._Gar Water Supply: Public System and name'-------------------------- private ] -------- - --------- --------------- ---------Character of soil to a depth of 3 feet: Sand' peat F1 Sandy Loam ❑ Clay Loam ,❑ Silt❑ Clay ❑ ❑ - e - _-"" "_-" Hardpan E] Adobe '' Fill Material ------ if yes,typ etc must be placed on reverse side.) (Plot plan-showing size of lot,vlocation of i system fi relation efmQtedofw uils,bli buildings, islavailable within 200 feet,} 'j r NEW 1NSTALL4. ATI,pN: (No-septic tank ore p g P P r� � Liquid Depth __---'t -- SEPTIC TANK�r� Size.._. _�'--x-•---- ---�---- ----- ---- q P PACKAGE TREATMENT [ ] r� � ,-%. ,�No. Compartments Ca acit � `- TYP `'` Material--- [ P Y , `•Foundation Pro Line ..��+R 1� �" = p ` Distancefto; nearest:.Well ___--_-,- - > - y -- 1 .. . -� — m Totalf'length LEACHING LINE- -- ------.1--- ------ Length of each lineTn _ Depth Filter Material .______-- -- - �-'-•"- , �t. 'D' Bo�~- Type Filter Mate 01 -- p f wti p -----/e7------------ Property Line ----------= Distance.,#o nearest: Well ----- - Foundation rr �._- . "_ . Rock Filled Yes No r Diameter .3-3-- -- Number -- - h s, r SEEPAGE [rill Depth --- --- ,mac Rock Size -1 •�` r V Water Table Depth f P nce to nearest: Well =.'_Y J f -------------Foundation ----1 4P--------- Prop. Line --------------------- Distance � �"" I Date ----------------------------------1 10 REPAIR/ADDITION(Prev. Sanitation Permit# ---- -- - ----- ---------------_•-- Septic Tank (Specify Requirements) ---- ------ ------------------------- ----------------------------------,..---- Disposal Field (Specify I Requirements) ---------!- . _ ............. _.._-.._..__-._.-_-.__.._-.__-..-.._..____..._.._.._ .. .......................... " _ -""-------------------------- ------(Draw existing and required addition on reverse side) """ lication and that�kie work wilC`be done in-accordance with San Joaquin I hereby certify that I have prepared this aQp County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or icen- sed agents signature certifies the following:' N 'v person in such manner "I certify that in the performance of`the work for which this permit is•issued, I shall not employ any as to become subject to Workman's Compensat►on I of California."' Signed ---------------- - == ' = Title - -= - ----------- (If other than owner) FOR DEPARTMENT USE ONLY . `'� _ 77 DATE . - --9-^. ---•-- APPLICATION ACCEPTED BY __ DATE ------------------- BUILDING PERMIT TISSUED ----------- -------------------------------------------------------------- ----=------------ ----------------------------------------------- ------------ ADDITIONALCOMMENTS', r------------------ ------------------------------------- - ------------------ - ---------------------------------------------------------- ------------------------ ------------ --------------------------- ...... ------- ------ ----- -------------- ----- ----Date-- - _--- ------ Final Inspection by: ----- - k SAN JOAQUIN LOCAL HEALTH DISTRICT . F. H. 9 1-'68 Rev. 5M. -°—