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APPLICATION-FOR SANITATIIONPERMIT- �- FOR OFFICE USE: Permit No. --------- (Complete in Triplicate) 2C7 Date Issue - ---- ---- ----- ,, -------- ------------------------------------------------ `------------------- ---------------- ------ This Permit Expires 1 Year From Date issued �O� ---------------------------- --------------------------- - - 7J Application is hereby made to the San Joaqu"in Local ,Health District for a permit to construct and instal! the work herein This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: described. CENSUS TRACT _ -------.Phone ------------------------------------ �- VA, JOB ADDRESS/LOC TION - ---- - Owner's Name �*a. City ----------- ---------------------------- - Address ---,� Phone _ License # ----- ----- ----- - - --- ------ Contractor's Name -�'�-- - •d,-�-�''''-�'-- ---- ----- ----- ---- ---- -- ----- - Installation will serve: R sidence-6Apartment House❑ Commercial❑Trailer Court ❑ ; Motel ❑other -------------------------------------------- ---=------- Garbage Grinder -- ------ Lot Size ----------------------- Number of livin units:_----__--- Number of bedrooms --------- 9 ---Private [11 ---------- ----- - j Water Supply: Public System and name --_------------- ---- --- Sandy Clay Loam ❑ Clay .Peat❑ Loam ❑ 'Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Y ❑ � Fill Material ---- ----- I yes, pe ----------------------------- Hardpan - -=--- ---------- - - -- - Hardpan ❑ Adobe ❑ buildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, sewer is available within 200 feet,) p p it permitted if public NEW INSTALLATION: (No septi tank or seepage p' p - - Liquid Depth ------------------ SEPTIC TANK'[ } Size------------------------------------------------ ----•---- -------- -- --•- --- - PACKAGE TREATMENT 4 1 No. Compartments ---------------- Capacit - Type -------------------- Material------ --. -- -- --- �> Y� -------------- - - - ---- - -- ---- ---•-Foundation ---------- ---- -----, Prop. Line---------•------.,------ Distance i to nearest: Well ---------- _ Total Length ------------•- LEACHING LINE [ ) No. of Lines -------------- I -- - ---------- Length of each line------------------------ Type Filter Material --------------------Depth Filter Material __--------- --- ,D, Box ----- yp Property Line ------------------ 1 Foundation ----------------------- Distance-to nearest: Well ------------------------ Rock Filled Yes ❑ No ❑ SEEPAGE PIT i ] Depth - Diameter -------------- Number ----------------- --------- -------------Rock Size ---------------------------- -- Water Table Depth ------------------------------------------------ --- ---------------------- Line -. ' -Foundation Prop. Distance;to nearest: Well ----------- I ---------- --------- - Date ---------------- nREPAIR/ADDITION(Prev. Sanitation Permit# -- ----------------:-----------------.-�---------------------------- r Septic Tank (Specify Requirements) ------------------ ; 4F' ---- - - ---------- Disposal Field (Specify Requirements) - ----- ---- ------------------------ ---------------- ' ------ --------------- i ----- =------ ------------- ------ (Draw existing and required addition on reverse side crab certify that 1-have- prepared this applization and that the work"wit! be done-in accordance with San or Joaquin r 1 h Y Count Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or icen- Y sed agents signature certifies the following: arson in such manner "1 certify that in the performance of the work for which this permit is issued, { shall not employ any P as to be me subject t Wor mans C mpensation laws of California." �I - Owner `'tet ------------------------ Signed - - � ------------ ____ -= ------ -- ---- Title (If other than owner) FOR DEPARTMENT USE ONLY - DATE 70---------- ------ APPLICATION ACCEPTED BY j DATE =-------------------------------------- -------------=--------------------------------- --------- -------------- --------- BUILDING PERMIT ISSUED -_------- ----------- ADDITIONAL COMMENTS -- -------------------------- ------- ' - -- ---- ----- -------------•------- -----�--� --------------- ----- --------- -- -- -- - - --- ---------- ---- ------- -- ate � ---------- -------------- - --• -- ------------------ - ---D Final Inspection b SAN 10AQUIN LOCAL HEALTH DISTRICT E- H. 9 1-'68 Rev. 5M