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FOR OFFICE USE:. APPLICATION FOR SANITATION PERMIT Permit No ------------------------- ------------------------ ------- (Complete in Triplicate) Date issued S� -=- " ---------------------- This Permit Expires 1 Year From Date Issue -------------- ----- : --------- Application is hereby made to the San Joaquin Local Health District fora 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 `P CENSUS TRACT --------------•----------- JOB ADDRESS/LOCATION - phone -------------------------------- --------------------------------- ------------ --------------------- ----- Owner's Name ---------------- •--_ City p Address - -- a ----- 001--(-------- License # " _a�__4 Phone p_ ` Contractor's Nam Reside ce ]Apartment NouseHouse,[] Commercial ❑Trailer Court [1Installation will serve: m -------------- Motel ❑other -------------------------------------------- --- ---- ------------ ----- Lot Size ----------- Number of living units:___-"--I__-- Number of bedrooms __ ____-____Garbage Grinder ----------- Private - Water Supply: Public System and name _________________ ___ peat❑ Sandy Loam ❑ Clay Loam Silt❑ Clay ❑ Character of soil to a depth of 3 feet: Sand ial ___"______"" if yes,type --- -------- Hardpan Adobe 'C] Fill Mater Ian showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 4 (Plot p r N NEW INSTALLATION: (No septic tank or seepage pit permitted if ublic sewer is available within 200 fee#, '.Liquid Depth ------------- - SEPTIC TANK� Size_ _ �-.�-�_-��- -------------- PACKAGE TREATMENT [ ] - / _ No. Compartments T e -��s Material__ - ----- �IQs Capacity l Yp f0 __ Prop. Line __._ i ___._Foundatto Distance tot ne rest: Well _____"____ j----------- Length' of each line--__" `- =--`,------- Total Length �- No. of Lines "" -- _ LEACHING LINE [�] ----- _5�. ,,.," .p _ } ' �-__.___ T e Filter Materia, ______________LL_De th Fikfier Material """��--------- - D' Box Yp I ------------ Property Line I Distance to nearest: We ---- %lam Number . Rock Fill Yes Na �] ` _ Foundation &tl '' ; ---- SEEPAGE --- -�- -----� E PIT [ Depth ""_-�,� _'D'+aineter --- -- •- ` ' S Rock Size _ - ` �. Water Table Depth -- - -- ' Foundation - - -�f1_ �__-_-- Prop. Line - _ - ------------ Distance to nearest: Wel{ ""_" I _ - Date ---------------------------- ) REPAIR,/ADDITION(Prey. Sanitation Permit F# ,j. ` F _ _____________________________________________________________ • _______________ _ Septic lank (Specify Requirements) _______________ r Disposal Field (Specify Requiremeri s) -___________________ -- ---------------------------- ___________________ ------------ -------------------------- __ -_-------------------------------(Draw existing and required addition on reverse side) be ne in I hereby certify that 1 have prepared this application and that�e Sa Joaqu n Local pHealth District. Hornce etowner or h Son Joaqu!" lieen- County Ordinances, State Laws, and Rules and Regulations of sed agents signature certifies the following: permit is issued, I shall not employ any person in such manner "I certify that in the-performance of the work for which this p as to become subject to Workman' pensation Laws of California." Owner Signed -------------- --- ----�-- ----------- ' -- ------ ---- Title ----- ---- -- - -- -- ---------- ---------- (I,f other than owner) ( FOR.pEPARTMENT USE ONLY DATE `-1----------7 ------------ DATE ---------------------- -------- ---------- APPLICATION ACCEPTED BY __"-- _ BUILDING PERMIT ISSUED --------------------------------------------------- ADDITIONAL ---- ------ ---- --------------- ADDITIONAL COMMENTS ------------------------- ----------------------. --------------- -•-=-- ------------------------------------------------------ ------------------------------------------------------------------------------------------------------ s"" --- c • ---- ------ ------ ----•---- Date -- ----- ----- - Finaf Inspection by: _----- - --- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT . ., , 'Aa D.., 5M