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FOR OFFICE USE: AIPF !CATION FOR SANITATION PERMIT w �' �- _' Permit No: �_ ^* —. (Complete in Triplicate) - ---------` ------ Date issued -- � -- This Permit Expires 1 Year From Date Issued Application is hereby made to the Son 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- ---------- egulations: ----:---CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION _-/ !------- •------ �_�li /Y--- t -----Phone Owner's Name` 7WR------------------------------------------------------------ -------- -- :------ - City _M_/y�0/�-�--------------------------- / Address ---- - ----- ------- ---- �-------- ----------------------------- -------- , -----------------------------------------------------License #� - 3-- Phone . =✓rr '� Contractor's Name __��---� -. Installation will'serve: Residence 2rpartment House❑ Commercial ❑Trciiler Court ❑ I I Motel ❑ Other ------------------------------------------- - F q r Number of livirig units:----1------ Number of bedrooms ---A----Garbage Grinder .00---- Lot SizeQ._------------ Water Supply: Public System and name ------------------ -------------------------------- -------------------------------- Private Character of soil to a depth of 3 feet: Sand'[--Silt❑ Clay ❑ Peat❑ Sandy Loam •❑. Clay Loam4. ❑ Hardpan F1AcYbbe ❑ Fill Material ----- ------ If yes, type - -------- ------ `l � V t i i {Plot plan, showing size of lot, location of system in relation to wells, buildings, etcmust be placed on reverse side.) _ (A, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK [G]�� Size--_ � -- r/r ------------- Liquid Depth -./- -rr-�---- --------- - P -�5---------•----- �► Capacity � �(�_ ��Type�1 L T Material /1� 0. Compartments l Distance to nearest: lWell -.JPO------------------------ -Foundation -_/. .------------ Prop. Line - ------=-------- LEACHING LINE [� No. of Lines ---.�-------_--_ Length of each line - Total Length -1rQ__.--------- 'D' Box �[' -- Type Filter MaterialDepth Filter.. Material _ - `-------------------------------- -- Distance to nearest: Well _ ' ------------ Foundation ---4P-r--------_ Property Line ----------------- SEEPAGE PIT [ j Depth -------------------- Diameter ---------------- Number ----------------------- Rock'Filled Yes,[] No .0 Water Table Depth --------Rock Size -------------------------'------ i Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --- ------------------ REPAIR/ADDIYION(Prev. Sanitation Permit# -------------------------------------------- Date __-_------------------------------1 Septic Tank (Specify Requirements) -------------------- --------------------- ------------------------------------------------------ ( , ' Disposal Field (Specify Requirements) -------------- ------------------------------- ------------------------------ ------------------------------------------------------------------------------------------------------------- • -- ----------- ---- --------- ---------------------- ----------------------------- - (Draw existing and required addition on reverse side) E 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, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: r "I 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 becom subject to Work n's Compensation laws of California." Signed -._ Owner ' ------------- Title ------------ -' f (If other than owner) s FOR PARTM T USE ONLY 1 APPLICATION ACCEPTED B 5 - DATE . -- ?.-Z1F `"; -------- ------------- BUILDING PERMIT ISSUED `_=_ ------ DATE tADDITIONAL COMMENTS ---------------------------------------------------------------------------- -------------- -------------------- --------------- ---------- ---------------------- --------- ------ ------------------------------------------------ ----------- ---- - - -- ------------- �----- - �- _ -- -- -- ---- --------- Date Final Inspection � SAN JOAQUIN LOCAL HEALTH DISTRICT ] E. H. 9 1-'68 Rev. 5M.