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FOR OFFICE USE: . APPLICATION FOR SANITATION PERMIT Permit No. -..-_-- -�-- --- �a -------------- # (Complete in Triplicate) ------------------------ -------------------- e Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made'in compliance with County Ordinance No. 549 and existing Rules and Regulations: CENSUS TRACT -------------------------- JOB ADDRESS/LOC ON ---�� ---�f-----F.:.� --�`/ ------------------------------------ Owner's Name ------- F�/27 - ---- - --- - - --- Phone - Address ------------------ - ---- - l� --• CitY ------- ---- ------------------- Phon � Contractor's Name ------------ --- ,�------ G -- --- --------------- Licens -------- Installation Installation will serve: Residence &JiKpartment House❑ Commercial []Trailer Court ❑ Motel ❑ Other -------------------------------------------- Number ------------------------------------------Number of living units:____--__ Number of bedrooms ----,1` ----Garbage Grinder _e1,-V--- Lot Size179------------- Water Supply: Public System and name ------------------------1----- ------------------------------------------ , Private Charadter of soil to a depth of 3 feet: Sand'❑ Silt❑%;r Clay Peat❑ Sandy Loam C] Clay Loam:❑ u Hardpan ❑ Adobe', Fill Material ---__-. if yes,type ---------------------------- ,4 (Plot plan,-showing,:size of lot, location of system in relation to wells, buildings, etc.' must be placed on reverse side.) NEW INSTAL ION: (No septic anor seepage pit permitted if public sewer is available within 200 feet,) \ "� Liquid Depth PACKAGE-TREATMENT { ] SEPTIC TANK;f ] Size--__--s---_-_.__-_-•------------ - k q p VN - Capacity �----------------- Type -------------------- Material---------------------- No. Compartments -------•--------•---•- Distance to nearest: Well -------------- -Foundation --.------------------- Prop. Line __----__----- --.--- No. of Lines ------------ Length of each Tine---------------------------- Total Length ---------------------------- LEACHING -----•--------------------LEACHING LINE [ ] -- -------- 'Q' Box --------- - Type Filter Material ---------------------Depth Filter ;Material ----------------- -------------------------- 1 to nearest: Well ___________________ FoundationF 1 --- Property Line. ------------------ i No i❑ Q SEEPAGE PIT [ ] Depth ----------- ---- --- Diameter ---------------- Number `----------------`---K- Rock Filled Yes '❑ Water Table Depth ------------------------------------ --- --------RocV,"Size --------=--------------•-------- • l oundation Prop. Line Distance to nearest: Well ------------------------------- F l Date ---------------------- ) REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------- i Septic Tank (Specify Requiremenfis) ----------------- Disposal Feld�(Specify Re irements) --- - - -------------- - ---- ---------- ----------------- -------------------- ------- --------------------------------------------------- ----- ---------------------------------------------------------- - - - --------------------- -------- - - -- ------------ ------------------ - - - (Draw existing and required addition on reverse si� e } r f I hereby certify that I have prepared this application d that the work will be donein accordance with San Joaquin an i County Ordinances, State Laws, rind Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 sh Iln' employ any person in such manner as to become subject to Workman's Compensation laws of California.'.' ] 1 Signed - ------------------------------------- Owner Title - BY ------------------ - ----- �.`;_- '- ----- t (If oth than owner) i ¢. FOR DEPARTMENT USE ONLY ! APPLICATION ACCEPTED BY - _-- ' - - --- -----------=----- DATE _-- --------------- ----- ----------- •--- ------ BEJILDWG PERMIT ISSUED ---------'------ ---- ' --- f=:1 -_'--------------------•-- __ DAiE = ADDITIONAL COMMENTS --------- ----- - ----------------------------------------- ------------ ------------------------------------------------------------------------------- � � - ----- ------------------------------------------------------------------------------------------- - - -- --- - - ---------- ' --------------- c � _ Final Inspection by. ---=- -- --- - - --------- - ---- ---- -- - ---------------- ------------ -----------.Date ---- 1------- SAN JOAQUIN .LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 54