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FOR OFFICE USE: APPLICATION-�FOR SANITATION PERMIT _.Z-sr Permit No. . ------------------------ ------- y (Complete in Triplicate) ---------------------------------- - Date This Permit Expires 1 Year From Date issued Issued /_! - _ rmit to construct and l !the work rein Application is hereby made to the San Joaquin ocal Health District Ordinance No 549 an8 existing Rules tand Regulations- described. egular ons- described. This application is made in compiiar'ice with ou ty JOB ADDRESS/LOC TION .._ t -------- ------CENSUS TRACT I -----° ----- - -- ---------- Owner's Name - ---- ------------------------ ---- City Address ------ -- °- ----------------- ------------------� ^ �.. License # 'P�rSne i Contractor's N - ., Installation will serve: Residence partment House Motel Commercial ❑Trailer Court'sC] _Gar ge Grinder - Lot Size -----------------= --------------------- Motel ❑ Other—___ ;�-__---- _=-�=____===-- Number of livin units: x� ,,Nber of be om g,_ . ,.:.. ---------zv Private ❑ Water Supply: Public System and name -- ---- ----- - = ' --- - _ = � . Character of soil,to a depth'of 3 feIt et: Sand❑ Silt❑ Clay ❑ L'Pea ❑ Sandy Loam ❑ Clay Loam ;❑ .,,. t Hardpan ❑ Adobe: Fill Material If yes,.type`--------------------- -- ii a laced on reverse side.} \ {P1'ot plan, showing size of lot, location of system in, r lotion to wells, buildings, etc. must b p i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 fees) SEPTIC TANK'[ ] PACKAGE TREATMENT [ ] � Size '*'I- ------------------------------------•-°---- ---- Liquid Dept -- h' T e _____--_ - No. Compartments ---------- Material_"'------------ ` � Capacity -------------- --- YPa = iDistance to nearest: Wella --------------�------ - ---:_Foundation ----------------------.Prop. Line-------------=---•---- I ITotal Length -- ----- ----- LEACHING LINE [ ] No. of lines ------------------------ Length of each line___ __ "- .. � f .. t De th Filter -Material-____ Box ----------- Type Filter Material _____ P "�{ ----__ Foundation ---- -----------------� Property Line: ---------------•-------- Distance to nearest: Well ------------- , SEEPAGE PIT [�] Depth -'-i_----.- Diameter ---------------- Number ------.---=----------- Rack Filledes ❑ No i❑ 3 Water Table Depth Rock Sze -------------- IT Distance-to nearest: Well ---------- ----• Fou ndation ---- -Prop. line -------------- REPAIR/ADDITION(Prev. Sanitation Permit -------------------------------------------- ------------ -,J , , -------------- _ `� - = k - r : Septic Tank (Specify Requirem�nts) ________-�------------- ------ ---- - .� - - " r�-`--�-"-------- " Disposal eld (Specify Re uire�nts]�-,_- - ----- t _h -•------- -------------------- -------------------------------------------------------------(Draw existing and required addition on reverse side) , ' application and that the work will be done in accordance with San Joaquin hereby certify that I have prepared this app County Ordinances, State Laws,�and Rules and Regulations of the Son Joaquin Locale Health District. Homeowner or iicen- sed agents signature certifies theE.)following: erson:in such manner I1 certify that in the performance of the work for which this permit is issued, I shall no' t employ any p as to become subject to Workman's Compensation JaWs of California." t I -- -------------- Owner nf� Signed I -- ---------- - r r v ' i (I th than own60 r *FOR DEPARTMENT USE ONLY 1 3 ' ------------------------ DATE p g APPLICATION ACCEPTED BY _ '--- ----- -------DATE ----------------- BUILDING PERMIT ISSUED __---- i--r------------------- - ---------------- ADDITIONAL COMMENTS =_=' -------------- -------------- ----- f ---------------------------------- -)-------------- -------_ -- ',------------•--------- - ----- --------------------- ----- -----•-- ---- ---- -- ----- Date --�--- -----�-- - -- --------------------- ------------- - ------- - ' Z ;� Final Inspection by: -« -- r SAN JOAQUIN-LOCAL HEALTH DISTRICT E. H. 9 1-'48 Rev. 5M