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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ��U7� �Q .y o.. -- _.��;,.�_.,___ r�.�>•.--•— --{Complete in Ti~iplicate}""-��_" _._____ _... �,..Permit - -- -------- ------------------------------- -------- ------------- Date Issued ��---fir---- -- This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein s made in compliance with County Ordinance No. 549 and existing Rules and Regulations: described. This application y ,/ CENSUS TRACT -------------------------- l ` ----- -�--`---� JOB ADDRESS/LOCATION .._�_; _ ----- n ------------------------ J ' ------ ---- ------------- 6� - --- Phone Owner's Name .___ ��' -- ' ----- City _--- -- -- ---'-- - --- Address ,F /' Phone ( - / lC '� _�- -License #/Iu / Contractor's Name ---------------- -----/�' ',' - Installation will serve: Residence` partment Nouse'❑ Commercial:❑Trailer Court ;❑ Motel ❑Other ------------ ------------------------------- ffk --------------------------- Number --of living units:_._----____/Number of bedrooms __Garbage Grinder �'' -- Lot Size - private - ------------------------- Silt Character of soil to a depth of 3 feet: Sand'❑ ❑ Clay ❑ --------------------------------------- ---- ------ - Water Supply: Public System and name ______________________ -_ _ Peat❑ Sandy Loam El Clay Loam El ; Hardpan F-.1 Adobe Fill Material ------ ----- If Yes,type ------------- -- -- -- - relation to wells, buildings, etc. must be placed on reverse side.) ` (Plot plan, showing size of lot, location of system m ngs, k NEW INSTALLATION: (No septic,tank or se page pit per if public sewer is available within 200 feet,) r p �_ r.: ..... ize,- Liquid p � i PACKAGE TREATMENT SEPTIC TANK' 14 J aL & : o..-/Compartments "�..__ = Yp . = Id / Capacity - -t- - ------•- T e -'� �-- - - Mates i Distance to near st: Wekl� ---------- = --Foundation -------------- Prop.Prop. Line ------- -------- LEACHING LINE` [ No. of Lines _------ -- -- Length of each line---- --_�-- - - Total Length . ---- -- - // ]tj 2 /� . s D' Box - - 5- Type Fil#er Material _! 1" _'� ---_Depth Filter j Mater�ai.__ �� q � f,_-_ Foundation _ _�--- Property Line. I o Distance to ne rest: Well _ - ----- Diameter �-------- Number --- __--------'------ �k Fille Yes No :❑ �' i d SEEPAGE PIT ] Depths,c�-_ D'_. - :.. )_�. i X - Water Table Depth -----=•------------ - Rock Size --- � ---- ---- Distance to nearest: Well ----------- f Foundation _ _®.-.-- --- Prop. Line _�----�- •-• - Date ----------------•-----------�----} �� REPAIR/ADDITION(Prev. Sanitation Permit -------------------------- ------------- �. ' ' ---z•-------------------f Septic Tank (Spec-ifyy Requirements) ---- ----------------------------------------------•------------------ Disposal Field (Specify Requirements) -------------- -----------•-- _ -------------- '------------ --------- ----------------------------------------- -------- ------------------------------- - ---------------------------- ------------ - t (Draw existing and required addition-on reverse side) I hereby certify,that i have prepared this application and that t[he,wark?vyill-be-done in accordance-with San Joaquin Y County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin local Health District. Home owner or iicen- sed agents signature certifies the-following: I i shall not employ any person. in such manner E "I certify that in the performance of the work for which this permit is issued, f as to become sub iect to Workman's Compensation laws of California." , Owner Signed 'r ` I Signed _- ------- ----------------------------- - � - � --- ---- ------ iJ�-` - - . . Title . ------ f , (If other than own , i ` �. FOR DEPARTMENT rLlSE ONLY �b J_ _________�___-____ APPLICATION ACCEPTED --�'--------------------------'------- _ DATE -- - ----- . DATE ------------------i I BUiLDING PERMIT ISSUED _____ -_____-- ------------------------ ------------ 7 ADDITIONALCOMMENTS ._. -----''-- --- -------`--------- -------- --------- --------------- ---------------------------------------------------------=--T------------- t------ `� -----------------------------'--------------------------------------------------------------------------- }: ----- ------- .. ----- J ---------------------------------- ---- f Final Inspection b - `-- ---.-= -°------- -------- ----•- -------- ---- ------ ---- - ---- -------- p Y y f 1 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1288 Rev. 5M. �1