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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT it 75�' Permit No. � ---��------ ---� --------------------------- ---------- (Complete in Triplicate) :, - Date Issued --- ----------------- ----------- ��-'"-- --O a -------------------------- - This Permit Expires 1 Year From Date slue Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein i pp application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. described. This app ' � *. ENSUS TRACT JOB ADDRESS/LO TION one ----- k ------------------ ------ --- Owner's Name - Ph --- City - --- --- ---- -- -------------------------- Address Phone license # ---------.-.------- Contractor's Name ------- Residenc43 Apartment House 1-1 Commercial ❑Trailer Court C1Installation will serve: Motel ❑Other -------------------------------------------- 7 ------------------- --_ -- ---- Number of living units:---- ------ Number of bedrooms ----------- Garbage Grinder ------------ Lot Size private El Supply: Public System and name ------------------------------------------------------- ---------------- ---------------- ------------- s Silt❑ Clay ❑ Peat F-1Sandy Loam -E1 Clay Loam, I Character of soil to a depth of 3 feet: Sand'o Mt�terial _------_.-- if yes,type ---------------------------- Hardpan Adobe ❑ Fill location of system in relation to wells, buildings, etc. must be placed on reverse side.] j JPlot plan, showing size of lot, V permitted if public sewer is available within 200 feet,) � NEW INSTALLATION: (No septic tank or seepage pit p p Liquid Depth --------------------------- 11" PACKAGE TREATMENT { ] SEPTIC TANK[ I Size----------------------------------- - -------------------------------- - Capacity ----------------.--- Type ----------------------- Material------------------- -- No. Compartments -------•---------=---• 1k,Distance to nearest: Well --------------------------- ---------Founddtion ----- ----- ------•-- Prop. Line ------ ---------- LEACHING LINE [ ] No. of Lines - Length of each line------------------- -------- Total Length ----------------------------- Filter -------------------------•- --------------------- - T e Filter Material --------------------Depth Filter Material ----------------------- ------ ------------- j 'D' Box ------- Type Line. Property ------------------------ Distance - - -----------------• i Distance to nearest: Well ------------------------ Foundation ----------- ----- ---- - . - -- Number -------------------- Water ------- ---- ------ ---- Rock Filled Yes ❑ Na i❑ Depth Diameter -------------- SEEPAGE PIT Water Table Depth ------------------------------------------------ ------------ - -------Rock Size --------------- ------------------------ t ------------ ---Foundation ------------- ---- Prop. Line ---------------------- Distance to nearest: Wel! --------------------- 1 i ---- ------- Date ----------------------------------------1 (Prev. Sanitation Permit# ------------------------------- - ------------------- .--------- -------------------------- 5eptic Tank (Specify Requirements) - -------------------------------. `� -_-- -------•--------•_--•-- 7 i ---- DIS sal Field (Specify Requirements] _--- - - "" , -- ---------- _ ---- ------ - - --- ---------------- -- ----- -- -- ----------------------------- ----------- ---------------------- ------------ - Draw existing and required addition own reverse side) with San Joaquin I y hereb certify that I have prepared this application and that the work wilt be done in accordance 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: permit is issued, I shall not employ any person in such manner "I certify that in the performance of the work for which this as to become s bject to Wo ma 's Compensation laws of California." Owner Signed -------- -d� ... - ----------------------------------- ____ -------- Title -------------------------- (if other than owner) FOR DEPARTMENT USE ONLY 70f -- -----. DATE ------^�°--- --- APPLICATION ACCEPTED BY - ---------- ----------------------------- DATE - ------------------------------------------------------ - BUILDING PERMIT ISSUED -- ----------------------------------------------- -------------------------- ------------------- ADDITIONAL COMMENTS ---_------- ------ ------------_-- k ---------------- --- -- ------------------------- --- - ------- ----- .7¢ 01 - - ----------------------------- Final - - ---------------- Date - - ------------------------------------------ --- Final Inspection by - - - �'' SAN JOAQUIN LOCAL HEALTH DISTRICT `' 3 ` . E. H. 9 1-'68 Rev. 5M