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_+ ,!�:: FOR OFFICE USE: Vt APPLICATION FOR.-SANITATION PERMIT - ------------ ---------- � �. Permit No. (Camp lete•i n�Tripli catel ------------- -------------------------------- Date Issued ------- --------------------------------------- .� This Permit Expires II Year From Dale Issued Application is hereby made to,the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is'madi in compliance with County Ordinance No. 549 and existing Rules and Regulations: i r - - - - - - -CENSUS TRACT .----------------------- JOB ADDRESS/LOCATITIsON . -`- -�- AJ - s Owner's Name f' = /Y _�•--- �- ----- Phone ------------------------------- Address ----- --------------------------------- --•--- City�r --- - r -- - '- `- ---------- s� �- License #fib-- t� .. �y� � Phc Contractor's Name ------ ��-------------- ----- e ,� n Installation will serve: ;'"''Residence VApartment House,[] Commercial ❑Trailertourt ',❑ ' . r" � � - ii t )Vkote F1 Other --------------------------, � /' �� ----- Number of living units:--- _:._'.Number of bedrooms ----Garbage Grinder _ Lot Size _ ._ Water Supply: Public System and name _ -- {l�r �f' ------ Privat ❑ e Character of soil to a depth of 3 feet: Sand T❑ Slit. ];Z:,,,.Clay E] t-peat-El - _SandyLoamT❑ Clay Loam :❑ Hardpan ❑ Adobe Fill-Material ------------ If yes, type ---------------------- ----- (Plot plan, showing--size-of lot, location of system inn relation to wells, buildings, etch must�be_plcd on reverse side.) NEW INSTALLATION: ,I (No septic tank or seepage pit permitted if public sewer is available within 200-feet, t . NO PACKAGE TREATMENT [ I SEPTIC TANK'[ ] gg Size--------------------------------------- - Liquid Dspth __----------------------- r ----- Material---------------------- No. Compartments ------=---------------- D --------------- Capacity '---------- --- Type -�---------- - i Distance to nearest: Well --i---------------------------------Foundation ---------------------- Prop. Line .-----}-----• -,------ LEACHING LINE [ I No. of Lines ------------------------ Length of each line----;----------- ------ Total Length __.____.---•;-------•-••;--- __De _ Depth Filter Material - -�-- .----------- -.- ' 'D' Box --- ------ Type Filter Material p Distance fio nearest: Well ----i___---- ------ Foundation ------------------------ Pr4erty Line ------ ------------------ SEEPAGE PIT [ ] Depth __._----_._ 4 - Rock Filled Yes No I❑ Diameter = Number ❑: i Water Table Depth ; -------------Rock Size -----------------t.-,-`-- ------------- . Distance to nearest: Well ------- ----------------------•-------•--Foundation�=------------- Prop. Line ........ ------------- -----------------(Prev. Sanitation Permit# ------------ =----------- Date ------------------------------------ REPAIR/ADDITION } i � � ,r Septic TanC(Specify Requirements) ------------------ -1r. = ---- -------- - !I '' --------- Disposal Field (Sfy.Requireme�s) ,_ - ° ---------- ----------------------- ------------------------------- - ------------- ------------------------- (Draw---- -- -------------------------------------------- -n and required addition hereb------------------------------------------------ ,. -- - - g q clition on reverse side) y 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 M "I certify that in the performancef of the work for which this per'mst is issued, I shall not employ any person. i suh manner as to become subject to Workman's Compensation laws of California." ; + Signed i Owner ; -- ------- - ---- ------------------------------------ Title _.C'��_�` i` i -- --------- r than owned { - FOR DEPARTMENT. USE ONLY �r APPLICATION ACCEPTED BY ------ ----------- --- QATE -- �d BUILDING PERMIT ISSUED ------ ------- - DATE _.. t ------------------------- ADDITIONAL COMMENTS --------I- ---------- ------------------------------------------------- -.,:------------------------------------------------------------------------------------------------- ----------------------- --- i .------------------------------- ----------------------------- t (� ---------------- --------------------------- ---------------------------------------------- Date Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM .� =