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FOR OFFICE USE: 'APPLICATION FOR SANITATION PERMIT •�'---------- --' Permit No. ------------ (Complete in Triplicate) , I ---------=---------------------------------------------- p C? Date Issued 7" ________. --------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: x\ JOB ADDRESS/LOCATIO _ ------ --��------�--- -- - --------- -- ---------------CENSUS TRACT -----------------_------- rr ' :. -- y � ~ Phone, I Owners Name ------------- ------- Address ---------- -------------------- City ____- 'L?0- - Contractor's Name ____________ __ ___ ___ - - ---- ---� - (T��1------=-=-------License #1��------- Phone ---- � - - /--- I Installation will serve: Residence XApartment House 17 Commercial :❑Trailer Court i❑ 1 iMotel ❑Other ------------------------------------------- Number of living units:----- --.- Number of bedrooms --_y-_Garbage Grinder -------- --- Lot Size ____��.--- - Water Supply: Public System and name ------------------------------------------------------- -------------------•---------------------- -----------Private ❑ Character of soil to a depth of 3 feet: Sand❑-"Sift -Clay-0- Peat I]—-Sandy Loam .l] Clay Loam s Hardpan ❑ Adobe X Fill Material.------------ If yes,type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted-if public sewer is available within 200 feet,) CPACKAGE TREATMENT [ I SEPTIC TANK[ ]}'I :4 Size--------------f--------------------------------- Liquid Depth --------------------.----- Capacity ------'------ - 'Type ---------------- '.Material--------------------- No. Compartments --------------_------- { Distance. to nearest: Well ------ - ___--._Foundation ---------------------- Prop. Line ----------------_----- LEACHING LINE [ ] No. of Lines .----------------------- Length of each line---------------------- ---- Total Length ,--------_------------_-__-- 'D' Box ------- -`_-- Type Filter Material ----------- --------Depth Filter Material Distance to nearest: Well ---____I_ Foundation ------------------------ Property Line, ----------------- i 1 SEEPAGE PIT [ ] Depth -------------------- ,,Diameter ________________ Num _ _ C]ber,.- - --------------------- Rock Filled Yes ❑ No Water Table Depth --------- ..--Rock__--Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -----------:----.----- REPAIR./ADDITION(Prev. Sanitation Permit.# ---------------------------------------------Date __----_---.---_-----_--_--_:_-----1 Septic Tank (Specify Requirements) -------- ------------------------- Disposal ---------------- ---- `, !�- Disposal Field {Specify Requirements) --------- `�C� - -- -------�'-�----- - ---------------- r - _ �' 3 x -mss ; - ----------------------------------- ------------ � r a . ----------------------- ��_ ------------------- ----------------------- ------------------- (Draw existing and required'additiori on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin C County Ordinances, State Laws, and Rules and.`Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: .� # "1 certify that in the performance of the work for which:this permit is-issued, l shall not employ any person in such manner as to become subject to Workman's Compensation laws of California..." A _ Owner ) Signed ------ ------------- - - ---- ----------- -------------------------------- By --- --------- a Tithe;- (If other n owner) FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED ----- DATE --� a4 - �'_Z.----------- t BUILDING PERMIT ISSUED ------ -----------------' - � --------- -----------DATE ---------------=- ---------------- --------- ADDITIONAL COMMENTS ------- ------ ----- f X-_ _ ---------------------------------------- ---------------------------------------------- ---------- -- � ----------------------- ---- - Date ---- Final Inspection by: - ------- N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M