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T .FOR OFFICE USE: �APPLICATION FOR SANITATION PERMIT Permit No,. -------------------------------------------------- ""- (Complete in Triplicate) Date Issued p- ---------------------- - ---- ----------------------- --------- This Permit Expires I Year From Date issued e work rein Application is hereby made to the Son Joaquinnan ec wial th JOB Counealth ty tOrd nan a No. 549 and existing Rules rict for a permit to construct and tand hRegulat ons- described. This application is made in ca p ��// . - - CENSUS TRACT -------------------------- Phone -------- ------ ------ -- • JOB ADDRESS/LOCAT ON ._'WK . ----- - --- - ------ •----- - Phone Owner's Name :._ Address - . -�- -�-------------------- ------- --•- ------ ------ - - =3--- Phone -�-- � - .. . =---- -License # ,9- SYS. - -- - ------- Contractor's Name _--- - - Installation will serve: Residence A-Apartment House'El Commercial :❑Trailer Court 11 { Motel ❑ Other ------------ ------------------------------ �.._.-_Garbage Grinder ��--- Lot Size -��- ---,-- ----------------------- Number -- -- �. Number of living units:___.. ---_ Number of bedrooms _ q Private ❑ Water Supply: Public System and name ------- --------------- -------- Cla Peat❑ Sandy Loam 0Clay Loam,,E] Character of soil to a depth,of 3 feet: Sand❑ Silt C) Y ❑ - Hardpan E] Adobe C�` -- if es Fill Material -_____--- ,type LL Y e ---- ------------- --- - - I, � Plot Ian, showing size of'lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I P NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size------------------------------------ ----------- Liquid Depth ------------ --------- Capacity Type -------------------- Material--------:---- -------- No. Compartments PY ------ ------- -.-, - Pro Line..--------------------- I Distance to nearest: Well ------------------------------------Foundation -------------- ---- p- Tota! Length ------------------------•---- LEACHING LINE ( I No. of Lines ------------------------ Length of each line------------------------ - 'D' Box ------ ----- Type Filter Material --------------------Depth Filter Material -------------------- '=-------------------- 1 Property Line � Distance to nearest: Well --"--------------------- Foundation ------------------------ Rock Filled Yes'❑ No Depth ""`` Diameter - ------ ----- Number ------ ------ -------------- SEEP�AGE PIT L ] P ---- - --- ----- ( C Wafter Table Depth -------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well --------------------------------- -----Foundation ---------------•---- Prop. Line --------------.... REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------------------- Rate --------------------------- ------1 Septic Tank (Specify Requirements] 'k-3 'fi %•-------- iremenfis Disposal Field {Specify Requ -------------------------------------------- ---- -------- ---- -- - - - - - ------------- ------- - - - - - I - ------- "--"-------- {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 and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- Gounty Ordinances, State Laws, 1 sed agents signature certifies the following: erson in such manner "I certify that in`the performance of the work for which this permit is issued, 1 shall not employ any p k as to became bject o Workman's Compensation laws of California." Signed ---- --------------------------------------- Owner 1 ----------- ----------- BY ---------- _ ----------------------------- ------------- - -----(If other than owner) FOR DEPARTMENT USE ONLY yr DATE __`�- ��--- ------- -------------------------------------------------- I APPLICATION ACCEPTED BY - -_- -- _-- ---------DATE -------- - ----• BUILDING PERMIT ISSUED ---------------------------------- --------------- ADDITIONAL COMMENTS --- -------------------------------------------------------- ------------------------------------------------------ --- {� -- -------------- -------------------- --------------------------------------------------------------------------- - -- ----------------------------------------- --- ate ------------------- ----------------- Final -------------- Final Inspection b �i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9^,1-'68 Rev-. 5M ,, �r