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f f i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -' - i --------------- - Permit No. ---- ------------•-� - .e (Complete in Triplicate) This Permit Expires 7E Year.From Date Issued Date Issued _93- --------_- ----------_-----_------------------------- 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 corrfiance th County Or ina ce No. 549 an existing Rules and Regulations: 4 `7 w y —n Ai 1 Mme• L ----- ---JOB ADDRESS/LOCAT N f `` � --- E=NteSU S TRACT ------- - RACT ! . Phone Owner's Name ---------- 4 `" Jdn0 � City Address -------- - ----- --- _ �_ Contractor's - � Name - `'�, --- -- -.License # .S `�D----- Phone --- `----- 5 Installation will serve: . Residence NKApartment House[( Commercial ❑Trailer Court ;❑ Motel ❑ Other -------------- ------------------------•--- Number of living units-----/--___- Number of bedrooms sem-------Garbage Grinder Lot Size --i,------`----'G�------------------------ Water Supply: Public System and name ------- -- - Private Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat r] Sandy Loam -E] Clay Loam Hardpan ❑ Adobe'❑ Fill Materialtype (Plot plan, showing size of lot,•location of system in relation to wells, buildings, etc must a placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet;}- ; PACKAGE TREATMENT [ I SEPTIC TANK f ] Size-------------------------------------------- -- Liquid Depth _- -------------.----- G 11 Capacity --------------------- Type -------------------- Material---------- ----------- No. Compartments -..-------------- Distance to nearest: Well -----------------------------------Foundation ----------------------.Prop. Line - .-----....----_-••- LEACHING LINE: [ 1 No. of Lines ------------------------ Length of each line---------------------------- Total Length ----------- . 1 'D' Box Type Filter Material ----------------- --Dept Filter Nlater,i.a��------------- t •---------------- �. Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line -------------------••••- kle SEEPAGE PIT ' [ ) Depth ____---- Diameter ---------------- Number -___ ----------------------- Rock Fit - Yes F] No r WaterDepth Table De p ----------Rock Size -------------------------- 1 -----------------Foundation - -----------------:- Prop. Line --------------- Distance to nearest: Wel! ____--_--- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _--_------- _----_- r l � � Septic Tank {Specify Requirements} -- ----------------------�---------- -------------------- -- -- =-;=--�;- • -- -:------------- -•�--;------------------------- --- --------------- -------- Disposal Field (Specify Require encs) - --' -- �lZ - = } -,p _ -------------------------------------- Y. -- - -__ ---- ------ --- -- --- ---- ----------- -- -_-- -------------------------------------------------------- ------------------------ --------------------------- 3-------------------------------- -- r - ------------------------------------------------------------------------- -------------------- -- � _ ,; --------------------- -------- -_ __- _ - i (Draw existing and required addition on reverrse'side) I hereby certify that I have prepared this application and that the work wilwe 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 bec9pe sub;ec to Work n's_CMpensati.o!) aaw of California." Signed :. ------ -- - -- --- Owner BY /�� - --- -------- r---- --------------- title f other than owner) FOR DEPARTMENT USE ONLY ,,II APPLICATION ACCEPTED BY --- ---------------------------- DATE 9"I D-' ---------- BUILDING PERMIT ISSUED ----- ----- 2_� ------- ---- -------------------------DATE ADDITIONALCOMMENTS #---------------------------- -------------------------------------------------------------- -------------------------------------- ------- -------- ---- --- - ----------------------------------------------------------------- ---- r ----------------------------------- { =--------------------------------- Date + F! J `------------------------------------------------ a e ---- - - t7 - Final Ins -�-- - -----1- - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M