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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -Z�-�S-�_--- --- --------------------------------------------------------- (Complete in Triplicate -------------------- -- --- P Date Issued t This Permit Expires 1 Year From Date Issued ------ -----I---------- - ---- -------------- truct and e work al alth rict Application is hereby mon is the adean compliance cwi heCou tytOrd Ordinance No. 549 and existing RulestalndhRegulationsrein rmit to cons described. This application CENSUS TRACT JOB ADDRESS/LOCATION � -a� hEr--R'A"------------------------------- ------ - ----.Phone - Owner's Name - ; s 0 - --- - - ------- City " --------------------------------------------------- Address ------------ J."-r' �f Contractor's Name 1 ' License # �� y Phone Installation will serve: Residence E]Apartment House❑ Commercial ❑Trailer Court� ',E] Motel ❑ Other e Number of living units:'__------ Number of bedrooms o1-___._Garbage Grinder ------ Lot Size --- Water Supply: Public System and name ---------------------------------------------------- ----- Private + peat Sand Loam Clay Loam:❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ ❑ y Hardp an F1Adobe ❑ Fill Material --------- -- if yes,type --------------- ------------ r (Plot plans showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} r N: No septic tank or see age pit permitted if public sewer r is available within 200 feet,} i NEW INSTALLATION: I p / i f � i ' PACKAGE TREATMENT [ I SEPTIC TANK j ��' i�� --- -�s- I.iquid Depth ---��------- ----------- � f Materia,-- - -�+�- No. Compartments __Z`------------ �Q ` Capacity cs- Typetsa' -- - 4!`` __ ' ° ' Foundation ----14-0------------ Prop. Line --'' � Distance to near st: Well - --------------------- � � W LEACHING LINE [�No. of Lines -- ---,_------ Length of each line_--___ 0-d_-- Total Length .:_-dew f ---� x [ --De Depth Filter Material __-1-7-__-._-_ �' D' Box -.'7.�2 --- Type Filter Material ----- ----'- bl ` o-� - Founddtiori �� Property Line -`r----------No---- Distance t nearest: Well --- • — � • - --- ---- -� Rock Filled Yes '171 ❑Depth Diameter --------------- Number ---------------------------- SfEPAGE,Pl7 [ l p :---- ----- f A-,= m Table Depth Rock Size -------------------------------- Water Distance to nearest: Well ------------------------------- -`------Foundation -------------------- Prop. Line ---------------- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- ---------- Date ----------- ------} Septic.Tank (Specify Requirements) -------------------- --------------------------------------------------•----.-------- ------------------- _. ---------------------------- --------{--`-- - � Disposal Field (Specify Requirements) ----------------------------------- -------------------------------------------------- --- ------------------------ ---------=----------------------------------------------------- i ------------------------- ------------------------- ------------------------- ----- ----------------------------------------------------------------------------- - --------------------- - (Draw existing and required addition on reverse side 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: "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." 1 Signed - ---�--------------------------------- - --------- ------------------- - --- --- -- -------- ---'--- Owner ----- ! Title - k BY (lf other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -. -------------------------------------------- DATE S't �i --------------- BUILDING .PERMIT 'ISSUED -------------------- -------- --------- ---------- ---------- -------- -------- ---------- -------- ADDITIONAL COMMENTS ----------------------------------------- ------------------ ------------------- i - ----- i' a " ---------------------------- Date ---------�- Final Inspection by- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M