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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,a Permit No. �------------- (Complete in Triplicate) Date Issued This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: y A JOB ADDRESS/LOCAT -1,�-r -------------------------- JA, CENSUS TRACT Owner's Name -f� ------ ----- -------- Phone _ - - Address _ S. _ GC --------:---- ----- 3g? --- ' City f ( - " -------------- t Contractor's Name -_:___.. ----- -- -- ------ -- Phone Installation will serve: Residence Apartment Houser-1-Commercial []Trailer Court i❑ Motel ❑Other ---------Z---------`-------- s----------:-:- 1 J Garba a Grinder .---- ------ Lot Size ------------ ------ ---------------------- Number of living units:_.__.-°___.. Number of bedrooms _____-__.__ g - ' Water Supply: Public System and name ------------------------------------- --------------------------Private [� Character of soil to a depth of 3 feet:-' Sand'❑ ilt F-1Clay E] 'Peat Elr'Sandy Loam (] Clay Loam .E] i Hardpan Adobe F1 Fill Material ------------ If yes, type --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) public sewer is available within 200 feet,) j� SEPTI TANK' Size- ---- ---- - ` /f Y1 NEW INSTALLATION: (No septic tank or se�ge pit permitted if PACKAGE TREATMENT [ [ - e Liquid Depth _____ Material-- ---.- No. Compartments __�----------- Capacity ------- TYP r e � 1 Distance to nearest: Well ---------�_b_�-----------------Foundation -----1-b_____----_- Prop. Line _- _--------------- I � LEACHING LINE+ [ No. of,Lines - Length` of each line_------�_'�_.p--f------ Total Length ___s --b__�_____________ } ---Depth Filter Material ----4------------------------ ------ � � 'D' Box .__.- --____ Type Filter Material __�!__�'-- Property Line ----�------•-------- ��.. Distance t nearest: We[,[ ----.�[x__----------- Foundation _--�-4�- -------- P tY ' '� k s � "� Diameter -�_ Number _ _ ______ Rock Filled Yes � No i(] SEEPAGE PIT [i Depth --c = f j .. sy = I'- J / Rock Size x Water-Ta ---- °------ -�----------------------------- f Distance to nearest: Welli----------h0----- - ---------- --Foundation (. CJ---------- Prop. Line _`j---- ---------- REPA1RfADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) - ----- ------------------ - -------_--. --------- ------------ - ----------- ------------ - ------ -..------------ - i ------------------•--- ----------- Disposal Field (Specify Requirements) -------- ------------------------------ --------- - ------------------ -------------------------- -------------- (Draw existing and required addition on reverse side) :K I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin. I 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 Com ensation laws of California." i Owner Signed --------- --- ------------------- . . ----- Ut Title --------- -- - ----------------- -------------------------- (If.other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - ------------ ------ ---------------- DATE _� `'`._'_�/------------------ - - ---------- ---- -------------------- BUILDING PERMIT ISSUED ------------------- ----- DATE ----------------------------- ------------------------------------------- ADDITIONAL COMMENTS ----------- ----------- -------- ----------- --------- --------------------=--------- --------------------------- ----- -- ------ --------------------------- ---------------------------------------------- -- --- ----------------- ----- ----- ------ ---------- Final Inspection by: - ------ Date -----./2 -- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M _.r