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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------- ------- (Complete in Triplicate} Permit No. .__�_ ___�=�_i w�- Date Issued1.�. .. ------------------------------------_--------------- This Permit Expires 1 Year From Date Issued i 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: � - � 1 -- ---------------CENSUS TRACT --------------•----------- JOB ADDRESS/COCA ION ---- --�- �R- -------------- _ C Owner's Name --- �---C .--•-------•--------------------------------------------------- --------Phone ------------------------------------ Address ------------------------- ------- Address c----- 1 � dt ---- City �-------------------------------------------------------- Contractor's Name � 1---C---------- ------------.License # Thane Installation will serve: ResidencegApartment House-E] Commercial ❑Trailer Court C] Motel ❑Other -------------------------------------------- Number of living units:-----/ Number of bedrooms __;3_____Garbage Grinder ------------ Lot Size � Water Supply: Public System and .name ----------i- -------------------•-----------------------------------.-•-_.----------------------------------.Private i' Character of soil to a depth of 3 feet: Sand'[], ,Silt❑ Clay ❑ Peat❑ Sandy Loam C] Clay Loam ;❑ �' Hardpan Adobe'❑ Fill Material ------------ If yes, type ____________________________ (Plot plan, showing size of lotraocation of system in relation to wells, buildings, etc. must be placed`on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) r .. �� 4 PACKAGE TREATMENT [ ] SEPTIC TAN Size__ � �/__________________ Liquid Depth ___f__.___._.________ \ _ /Ja �� Capacity ./ _ TypePM.-_(=_ �1�/_ Material_-fe��_____ No. Compartments_ p ------------ Distancey to nearest: Well -__ _ �_____________________Foundation /C)__---------- Prop. Line LEACHING LINE [ � No. of Lines ------�---________ Length of each line_��4_`-/6.0_r Total Length ,_____ moo_'____ D' Box .__'/_---- Type;Filter Material - �1C't _Depth Filter Material ____,�_ ________________________ __ F 4 V Distance to nearest: Well -------------- Foundation -------------- Property Line --- SEEPAGE PIT � Depth _________ biometer __�a_______ Number ---------- --- __________ Rock Filled Yes No ,O frr � r t Water Table Depth ` Rock Size --------•------ >„Distance to nearest: Well ___ Foundation - - _�____ Prop. line ........... REPAIR/ADDITION(Prev. Sanitatiorti re.hit# ____________________________________________ Date ________._-_________..__-.......__) A Septic Tank (Specify Requi'rements) j----------------- ----------------------------------------------------------------------- ------ Disposal Field (Specify Requirements) -------------- ----------------------------------------- :--------------------------------------------------------------------- -------------------------------------------------------------C* ---------------- --------------------------------------------------------------------------------•---------•------------ ,(b(aw existing and required addition on reverse side)-vi I hereby certify that I have prepared this application and that the work-will bi 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 : v "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 bec phe su ject to WTrkm �'s�Compensa ionlaws of California." Signed _� - � � 't 9 - -----� Owner By --------- ------- -�= Title -------------------------------------------------- (If other tha' owner) �OKIDEPt#j1TMENT -USE-ONLY — APPLICATION ONLY —APPLICATION ACCEPTED 8Y . DATE ,- 1--- -------------------- BUILDING PERMIT ISSUED ----------------------------- ------ --------,'r--------------------------------------------DATE -------------•------------------------- ADDITIONAL COMMENTS --------------- Z----------------------------------------------------------------------- ' 4l� --------------------------------------------------------=--------------------------- ---------------- ----------------- ------ ------------------/ ----- Final Inspection by: __ __ -Date _- -________ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.