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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / = Permit No. (Complete in Triplicate) ---------- ---------------- --------------------- This Permit Expire1 Year From Date[slued �� Date Issued -------------__-- --------------- --------- s Application is hereby made to the San Joaquin Local Heath District for a permit to construct and install the work herein described. This application is made in compliance witA County.Ordinance No. 549 and existing Rules and Regulations: (�� ++ JOB ADDRESS/LOCATION .--- d_ -------- 4_______-_-- _ °---CENSUS TRACT -------------------------- .t -------------------Phone�b�f - --- -- Owner's Name - Address - k i `-----------_ :- City ---------------------------------------- Contractor's Name _._---____.- . -- -__ License # -1�.�11----- Phone Installation will serve: Residence VApartment House-E] Commercial:❑Trail r Court i❑ Motel ❑Other ------------------------------------- Number of living units:------- Number of bedrooms ____Garbage G�inde"r _ Lot Size _ x_. --------------- Water Supply: Public System and name ------------------------------------�"_i- ---- - Private.J�,,�' - ---------------- ------ - ,i�, 4 - _ _ - Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.E] i� t � Hb rdpan Nr ,Adobe Fill Material _*...___ If YL s, type#---------------- (All Plot Ian, showing size of lot, locatio of system in relation to wells, buildings,-,.etc. must be placed on reverse side.. ( p NEW INSTALLATION: (No septic ton�`or seepage pit permitted if public sewer is�ailable within 200 feet,) o� PACKAGE TREATMENT [ ] SEPTIC TANK'[_] Size----'------------------------------------------- Liquid Depth --_--------------_- W i Ca acit � C T e -_--____---__------ Material------_:- ------ _ No. Compartments -------------.----•--- p Y --- --j�--- Yrp , -Distance to nearest: Well ------------------------- ' '"Foundation -------------------- Prop,. Line --------------:------- f r, _ l ai LEACHING`QINE- • [ ] No. of Lines -------------=---- - -- L"ength, of�each line,- -lf,<.------------i.-_---- Total Length -------//-------------•-.--- 'D' Box .-----i-_--- Type Filter Material ____________________Dep------ i r Material --------------------- ------------- ----- nearest: Well ______\_______ ______ Fou dation(-1--------.______ --- Property Line_________._____--::---- I SEEPAGE PIT [ ] Depth _.______ ._ --------- Diamete� �'''Ne' ----------------- Rock FilleYes ❑ Na i❑ Water Table Depth ---- ---------- � --Rock Size ----------- i Distance to nearest: Well! ._�__________-1-------_-----------Found'ation ___________!:______ Prop. Line ----------------------- INREPAIR/ADDITION(Prev. Sanitation Permit# ------------------------- --------- -- Date -------------------- --------- Septic Tank (Specify Requirements) ---- ° -- f ----------- - - Disposal Field (Specify Req.}irements) l�--�-- ------------------------------------------ - 1 -------- �-• ---------------- - (Draw existing and'req 6ired-ddditioA n reverse side) I hereby certify that I' have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, aVd Rules and Regulations of the San Joaquin Local Healthh District. Horne owner or licen- sed agents signature certifies the fo lowing: "1 certify that in the performance of the work for which this permit is issued,`I shall not employ any person in such manner <-- as to become subject to Workman' Compensation laws of California:"K"�,C A Signed -------------------------------- ---------- •------- - ---------------------------- Owner do BY r ---- Title ---- -- ��------- --------- -- - -- - ----------- (If o ber t owner T_ t -:DEPARTMENT SE ONLY-- J- ' BUILDING PERMIT V55UED -- - -- --------------------- ----------------- DATE -- — ------ APPLICATION ACCEPTED BY -------------------.------------------------------ ------------------------=--------------DATE ------------- -------- ----- ---- ADDITIONALCOMMENTS ---------------------------------=----------------- -•------- - '=--------------------------------------------------------------------------------------- ------------- - --------------------------------------------------------------------------= ----------------=-------- ----------------------------------------------------------------------------------- --------- ---------------------------------------------------------------------------------------- --------------------------------- - =--------C`----- -------------------------- -------------- Final Inspection by. °= �'-[-- - -`, ---------------- Date = SAN JOAQUIN-LOGAL HEALTH DISTRICT E. 14.'-9, 1-'66 Rev. 5M. -�