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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------------------------------- ----- Permit No: - -!_------�(!J./ (Complete in Tnp icate Date Issued ------------------ This Permit Expires 1 Year from 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 Ordinance No. 549 and existing Pules-and-Regulations: - _.--___---CENSUS TRACT Sy-�' JOB ADDRESS/LOC AT ON .---��------ � 1/ ------------------ --------------- Address Ph on`"a'",..�. --- Owner's Name - _L.-_ _________________ AddressrF �J dC` ------ ------ ------------- -- -- Contractor's Name . ---.License # l Y--- Phone t --- - - --- Installation will serve:- '°-Residenc [1°-Apartment-House-❑ Commercialf Trailer Court-,E] ^-- Motel ❑ Other ______ - ---------------------------------- Number of living units:---- Number of bedrooms . _____Garbage Grinder ---- Lot Size ___________--_-__________________________ I Water Supply: Public System and name -----------------------------------------------------------------------------------------------------------------------Private Peat Sand Loam C[a Loam: t Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ❑ Y E]..-- Y a Hardpan ❑ Adobe❑ Fill Material ______ -- If yes, type ---------------------------- 3 ; a; [Plot plan, showing size of t, location of system in relations too wells, buildings, etc. must be p[aeed on reverse side.) F p see age pit permitted if public sewer is available within 200 feet,) f i { _ -.11 -.1 y ....�..-.-t PACKAGE TREATMENT SEPTIC TANK' Size$_XJP___�-- °---`---=-- ----,Liquid Depth `+` ---------•--•--- �, NEW INSTALLATION: (No septic tan or [ r� Capacity -- 50a Type - --------- -- -- Material__-4''�- ------ No. Compartments ___- d -- ---- Distance to nearest: Well _ Q____________________Foundafion ____ /a------------ Prop. Line ---------- -•--------- LEACHING LINE [ Jr No. of Lines ----------q____._.-_ Length of each line__-____.� --f.------ Total Length __ �-----•---- - 'D' Box __:. _._ Type Filter Material 5 1�-------Depth Filter Material -------I_ ________________ ___--.-_.-_-- . ' Distance t nearest: Well ------_50 Foundation ---------l-Q ----- ----- --- ------ Property Line. . -.. -III T" E SEEPAGE PIT [ ] Depth --------- Diameter -------------- Number ---------------------------- Rock Filled Yes ❑ No C] y, - Water Table Depth ________Rock Size ------------------------------- Distance to nearest: Well ------------------------------------------Foundation -------------------- Prop. Line -------------------- REPAIR/ADDITION(Prev. Sanitation Permit# _._ ------------------ Date --------------------------------] Septic Tank (Specify Requirements) _.----------- - -- ----------------------------------<-------------- Disposal Field (Specify Requirements) __________ - --------------------------------------------- -------------------------------- ------------------------------------------------ ---- - --------------------------------=------------------------ P ------ ------------------------------------- --------------- ------------------ (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, 1 shall not employ any person in such manner as to become subject to'Workman's Compensation laws of California." Signed ----------- --- 'Cyx+rrtr f �- Title --- -- F (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _��_ -- r DATE ----�1"---- ----�-- -- ------------------- --------------------------- --------------------------------- BUILDING PERMIT ISSUED ------- -------------- --------- DATE ---------------------------------- ------------------ ADDITIONAL COMMENTS -------------------------------------------------------- ------------------- -------------------------- --------------------------------------------------- - - --------------------- ------------------------------------------------------- _ _ ---------------- -------------------------------------------------- ------------------------------- -------------------------------------------- -- - - - - - Final Inspection b Dafie _1 _----- ---------- -- --------- SAN JOAQUI LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.