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FOR OFFICE USE: APPLICATION ,FOR TSANITATION PERMIT _-----}------ ---------- --------------- i- Permit No. . `q (Complete in Triplicate) / ----------- -- ________._ This Permit Expires ] Year From Date Issued Date 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 made,in compliance with County Or finance No. 549 and existing Rules and Regulations. ' ------ ------ ' / t� `� - r___-- .---- --CENSUS TRACT JOB ADDRESS/LOCATION . ! ----- -------------------------- Owner's Name --A •-------------= - - - --- - - -.- - - - - -- Phone -------------- - ---- -- - Address --------------------=-- /, y ' Ciry --------- --- ---- -- --------- - --- --- ---------------------------------------------------------- Contractor's Name -- �'�- . !__ _ ___.License #o��a_ / _-- Phone ! _ Installation will serve.:' - ResidencekApartm t House❑ Commercial :❑Trailer Court ',❑ Motel ❑Other -------------------------------------------- Number ---------------- -------------------------- ) 1 �,r�� Number of living units:--- Number of bedroyom®sem _.__.Garbage Grinder ___�-.��__-. Lot Size C"I__ ___ __________ Water Supply: Public System and name ___= ' G______ _________.___________ ____________ -x--private ❑ PP Y= Y Character of soil to a depth of 3 feet: Sand r Silt❑ Clay ❑ - Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe '[k Fill Material' fir_ If yes,type ____._____________________ (Plot plan, showing 'size of lot, location of system in relation to- wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION:' I (No septictankor seepage pit permitted if public sewer is available within 200 feet,) oe 1 PACKAGE TREATMENT [ ] ..–SEPTIC TAN Size Sizey__�_��+_ _ .._._.2�'f�_ __---__ Liquid Depth ----r,.5 .-_--___----___ Capacity/_.i--�O__�X4—Type �.�-� Material_.C3+ No. Compartments -------------•-- Distance to nearest: Well --- _ d -- ---- --- ----Foundation «------__ _ Prop. Line ------------------ LEACHING LINE ' No. of Lines ------/___-____-__ Lr,11 of each line.__ _.,�C __P_y______ Total Length ----------------------- Mat P D' Box . _ Type Filter _. __- epth Filter Material _._l o� ----------- Distance to nearest: Well --- ------ dation ____. ----_---_---__ Property Line --4_---_-_-__ SEEPAGE PIT Depth .___rr - �_. Diameter __ _� Number _.__--'_ ______________ Rock Filled Yes No C] ----12— A -- Water Table Depth \--------- ---- --------------------------------Rock Size -------------------------------- Distance to nearest: Well ------l6:9----------------------Foundation __--- Prop. Line _----~_-r REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _-__-___-_________________________) SepticTank (Specify Requirements) -------------------------------------------------------------------y----------------------------------+---------------------------- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- a -------------- --------------------- -- --- ------------ ----------------------------------------------------------------------------------------------------------- -------------------------------------- (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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -- ----------------------------------- ---- ;- Owner By t ! . -------- Title ------ (if other than owner) w R D TMENT LISE APPLICATION ACCEPTED B .----- ---------------------- ' DATE -= ''T BUILDING PERMIT ISSUED ----------- DATE ADDITIONAL 0 AMEITS ----------- --------------------------------- ------------ ------ ---- ------------------------------------------------------------------------------------------- ---------------------------------------------------- I C� -- -- _ . ^�� -f --------------------------------------------------------------------- ------------------------------- --- FinalInsectionbY;\ - _ .Date 4._ ------- --------- ------ F ______ ,SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M