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i` FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i Permit No: s (Complete in -. - --�. Tnplitatel --------------- This Permit Expires i Year From Date Issued Date Issued -_ :_ - -8 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 a'nd existing Rules and Regulations: E JOB ADDRESS/LOCATION .---_-- --- - ------_ _ Rwl,-_ ENSUS TRACT -------------------------- --------------C Owner's Name ------ ------- .---. ✓_ _- Phone &- -- -- Address ------------------ _f------ - City -- :------- - -------------------------- ...__. Contractor's Name .__ .- - ' 7-� ----.License # ------- ,__----------- Phone _T(_ _ Installation will servL#:T T--Residence❑p;pa rn-ent-H u�s�e'[] Commercial-oTrailer-Court-❑— -, E Motel Other --.-`- _--- Number of living units______ ___ Number of bedrooms _--- -----..Garbage Grinder - ^- Lot Size Water Supply: Public System and name -_ �TH R7_P'�.: -___ T ----- Private ---------- . ❑ Character of soil to a depth of 3 feet: Sand' Silt y-.D] ❑ -Sandy Loam Clay loam [� �� ' ti p 1 ❑ ❑''.-�Cla-� Peat 3 Hardpan ❑ Adobe-E] Fill Material -tQ_- If es, ' F TI' '6) ,allot'plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) _NEWFINSTALLATION:k (No septic tank or seepage pit permitted if public sewer is ava,lld,151 within 200 feet,] PACKAGE TREATMENT f ] SEPTIC TANK'[ ] � -_ Size_--_1��1-_____----.--- �.__ ---' Liquid Depth ------y�__.-_-_---_ __. . .�T.., -6� Capacity . Type] ],9r �---_--_ Mat rial- l�slt�n¢�_ No. -Compaftments -------------- Distance - Z Distance to nearest: Well --- Foundation _' � - }-- �=----------` ----- - �. �------------- Pro":'Line -------1-`1---------- LEACHING LINE [ ] No, of Lines ---,._o -_:-______�.- .Length of each line- - - Total Length '-----j----_____________ E p Depth Filter Material ` --l. ---__------ /� �. 'D' Box ----✓-- Type Filter Nlateri I -fLB __--- -_ p . Distance to nearest: WellFoundation --__- -.-.___ -�TProperty Line -_ -----� ------ SEEPAGE P!T , f ] Depth __ ___- -_- A 'Diameter ---------------- Number c s ❑ No i❑ A • _ k Filled Water Table Depth ----------- '--------------------•---. Rock Size . ------- -------'- -` ' I Distance to nearest: Well ------ ----------------------------------!F6undation -.___{ ------------ PropAine ---------------------- ' REPAIR/ADDITION(Prev. Sanitation Permit# -_---___._f_- < ��"- I }r ' l -------------------- Date ---- --------- . Septic Tank ]Specify. Requirements) ------- --- ------------------------------------------------ ,C ! Dis,posal,�Field t,(Specify Requirements) k :_ s�IV L . .. - --------; --- - ------- --- f ---------------- i f (Draw existing and required addition on reverse side) I hereby certify-that I have prepared this ap'plicatio'n and that the work will be done in accordance with San Joaquin i County OrdinariceS�State"Laws, and Rules and Regulations of-the San Joaquin Local Heplth District. Home owner or licen- r sed agents signature certifies the following: "I certify that in the performance of the work for which this _permit is issued, I shall not employ any person in such manner *t as to become subject to Workmpr�'s Compensation laws of California." �' r -LL '"""' Signed ----== ---------- -------------- ------------------------------------ - Owner'• By ------- --- ---------- r" ' ----------------- ` `l Title - (I o her<2n owner) ' ---------- t----- ------ ----------- ------------------------ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ri_R V------------------------------- -- ------------------ DATE ---.Lr7_` r 4 BUILDING PERMIT ISSUED -------------=---------------------------------------------------- -------DATE ADDITIONAL COMMENTS .------- -------------------------------------------------------------- I- --------------------------------------- - - - ----------- - ---------------- ------ - - �l--- ----------------------------------- ----- - --------------- -- ----- ------ -- - ----- ----------------------------------------------------------- ----- ---- --- - -- ---- ---- ---- -- - ------------ - - ---------------- Final n b : - Date - --- -� = SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M