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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --------"" (Complete in Triplicate) " _-- ------- Date Issued --------- issued ------------------------ ----- ------- _ This Permit Expires 1 Year From Date slue ------ ----------- ------------- --- . struct and l the work herein alth rict for a rmit to con Application is hereby made to the Son Joaqucompliance l+wan ecal witheCou tytordinan a No. 549 and existing Rules tand Regulations.. described. This application is made P _CENSUS TRACT JOB ADDRESS/LOCATION ._�C", -- � Wit' � Phone ��1--1--------------- Owner's Name 11uC� J--- .... ------- f - --� Cit --- ----- - ------------- -------•-------- Address ----1�O -G'-TAA---w� -- -- -------- ------- ----------------------- - Y ---- ------ �� °'191 2. -------------------------------- ---------------------- -------- License # Phone ��.,.--- --------- Contractor's Name - __--- -��- Installation will serve: Residence [(A artment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other ---------------------------------- ------ - � ,� .� _"_-__ Number of bedrooms 3__ __--Garbage Grinder __��- Lofi Size ._-------=---- ------- ------ ------- Number of living units:__ Private Water Supply: Public System and name -------------------------------- Peat _. Sand - Loam ❑� Clay Loom 0 Clay. ❑ C❑ Y _M Character of soil to a depth of 3 feet: Sand'❑ Silt❑ .� es,type ------ ----------------- Hardpan ❑ Adobe� Fill Material ------------ If Y Yp --- I {Plot plan, showing size of lot, location side.) of system in relation to wells, buildings, etc. must be placed on reve NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) q� it ------ Liquid Depth --� ----- ----- C TANK Size -- -�--X--j--�--�--�-------------- --- - q p � PACKAGE TREATMENT [ ] , (,, r�r Material ' ' � ------ No. Compartments SEP Capacity �r Type f Foundation "� Prop. Line .- Distance to nearest: Well - "._ E 't Length of each line.--So- Total Length ---�"-ip---"--------- So----- - - LEACHING LINE [\ No. of Lines -- fd ` r L 'D' Box .__ -- Type Filter Material -Depth Filter Material-, -- :----- - Pro' er Line .15------------------ Foundation - p y Distance to nearest: Well .-&5-------- - - ---------- --- Depth :-- Diameter Number .._ r``-- = Rock Filled Yes 0 No I❑ SEEPAGE PIT [ ] ------ --------------- t --------------------------------------- Foundation -------•-- - -----Rock Size ----------- ---------------- - Water Table Depth _w"------------------------ r " Foundation. --------------------'- Prop. Line ------------ --------- Distance to nearest: Well `F'------------------ REPAIR/ADDITION(Prev. Sanita#ion Permit _.------- ---`--- --- ----- Septic Tank (Specify Requirements) ----------------------------------- ------------------------------------------- -------------------------------- - ----- --------- Disposal Field (Specify Requirements) "- - - , -----------------------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 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 Compensation laws of California." _ - ---------------- Owner ---------- ------Signed - ------------------------------- - -- ---------------------------- Title ------------------------ - - ------------------------ (lf other than owner) �Y FOR DEPARTMENT USE ONLY v ------------------------ ---- ------------------ DATE �?. 's��'4" --- -------------- APPLICAT[ON ACCEPTED BYYMN�1- ------- - ----- ----------�---- ------ -------- ------------------DATE ------ ----•--------- -------------- -- BUILDING PERMIT ISSUED -- ---- --- -- AD 1TIONAL CO ENTS C--- -- --- - __ __ ---------- --------------:- i--,-----------�-------.------i-.--.--.-� -------- --------------- ----------- -------------------------- -- �' -------- Date ------------------ ---- Final Inspection by: __- _ -___. - --" "- - F ,.. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H:9 1-'68 Rev. 5M _