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FOR OFFICE USE: pppLICATION FOR SANITATION PERMIT Permit No. --- -------------- Date (Complete in Triplicate) = / .�� ,-� � Date lssued _-l<--�---- --� - 3 ------------ "" This Permit Expires 1 Year From Date issued ------------------------------------ ---- Application is hereby made to the San Joaquin Local Health District for a pe to construct and install the work herein ed. This application is made in compliance ith County Ordinance No. 549 and existing Rules and Regulations: described. ---CENSUS TRACT -----------------•------- s JOB ADDRESS/LO Ti N ---- ------ ---- a --------------------- Owner's Name ---- - "-� �- i - City - -- --- - - ----------------------- Address •---- -------Address ---------------- /� y Phone -- ----- s -.License # -Q! -- - ------ ------- - Contractor's Name Commercial ❑Trailer Court Installation will serve: Residence Apartment House❑ ` I Motel ❑Other -------------------------------------------- --- ---- ---------------------- -- - ---•- A� _�---- Ga bage Grinder._n Lot Size __, -----Private ❑ Number of living units:------ Number of edroo s __- � _� --------------------- Water Supply: Public System and name ------ ----------- --t___ "" ❑ CPeat❑ Sandy Loam ❑ Clay Clay Loam .0 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Hardpan E] Adobe ill Mat- erial - ------ if yes,type - - _"" ___"" _"." uildings, .etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to .wells, b NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet, iSize_ ----- ------�-------- - ----------------------- Liquid Depth �---------- k PACKAGE TREATMENT ,[.] " SEPTIC TANK'T-] ----- = No. Compartments Type -------------------- Material------- Capacity ------ Ca acity ------ - w r -------Foundation ----- ----- ----------.Prop. me -----------•----•----- Distance to nearest: Well --------------- -- Total Length ''. No. of Lines /`� Length of each line ------------------ LEACHING LINE [ ] y" ' De th Filter Materia "---------- - ----- D' Box ------------ T Pe. Filter Material ""-" p _. - -_ i a Property Line • __ Foundation -------- ----------- - ( Distance,to nearest Well ---------------------- Rock Filled Yes ❑ No ` Diameter __---------•- Number --------------------- i SEEPAGE PIT [ ] Depth ------------------- 0 Water Table Depth ------------- Roc Size - ----------------------- r ' -----•---------- -Foundation �- ------------------ Prop. Line =-------------- - i Distance.to nearest: Well --- _----------- = pate ---------------------- ion Peit# REPAIR/ADDITION(Prev, Sanitat ;------- - 1 ------ --------------------- el I ecif Requirements) ------ -- = Septic Tank (Sp Y -------- ecif Requirements) ----------- *. Disposal Field p Y - - ----------------------------------------- -------- --------- ----- --------------------I--------- ---------------------------------------------------------------------- ------------------------ - - - --------------- -------------------------- - (Draw existing and required addition on reverse s� ein ereb certify that I have prepared rthis application and,that the a orJ County Ordinances, State Laws, Local health D str t HOn et Ih y owner or I cen- and Rules and Regulations oft e sed agents signature certifies the following: ern+it is issued, I shall not employ any person'in such manner` "1 certify that in the performance of the work for which this p E as to become subject to Workman's Compensation laws of California." I . Owner it _ --------------------- Signed Title ------ ° ------- --- -__.__-- w �. + Y ---------- er than owner) I �' P RTMENT LISE,ONLY ' DATE ---11 -=------------- s APPLICATION ACCEPTED BY -------- -- ' - ----- ------------- ----- -- - ------ - DATE ------ ------•'--- ------ ----- ------------ :' k BUILDING PERMIT ISSUED -_____ ---- - , ADDITIONAL COMMENTS i `. 7 4--------- + / { ------------------------------ ---------- - - Date j- �-{ 7- ---------- I Final Inspection by: _ _ --------------------------------------- SAN JOAQUIN'•LOCAL HEALTH DISTRICT F H. 9 1-'68 Rev. 5M