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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --------- ----------- -------------------------- t (Complete in Triplicate) -------------------------------- Date Issued ----------------- __-- This Permit Expires t Year From late Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein ith C ,unty Ordinance No. 549 and existing Rules and Regulations: described. This application is made in compliance w JOB ADDRESS/LOC CENSUS TRACT ____________.. ---------- fl = z ne Owner's Name G { v ----------------------- &� Pho , Address --- --- � _a� _ ----_-- -- -- ---•- C fi -----------------------------•----•--- Y Phone --------------------------- #` r - Contractor's Name ------ s ----- --- - - -- ------- License -Z- --- Installation will serve: Residence Apartment House[] Commercial❑Trailer Court iD Motel ❑Other--------------- ------- -- --••------------- Number of living units:___.I ______ Number of bedrooms -----Garbage Grinder ------------ Lot Size __________________ _____ __________Private* Water Supply: Public System and name -------- ------------• ----------------------- -- - -------------------------------------------- I Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,0 I Hardpan Adobe'❑ 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.) ` T NEW INSTALLATION: (No septic tank.or seepage pit permitted if public sewer is.available within 200 feet,) i SEPTIC TANK // Liquid Depth ___`�` -------------- PACKAGE TREATMENT f Size l --/Y '-. ,-I� - q -p � �. o i Capacity -�_�Q -- ---- Pe - = Material_,_ "�'--- Nod .Compartments __• _. -------- Ty D � i '. Distance to nea st: Well ---------------------------=--------Found'ation ----1-------------- Rrop.,Line ------s_..�-•--- r __ LEACHING LINE � No. of Lines ______- __ Length of each.line____.___ ---- Total'Length.--.---- <T__.._d._.__--_--- �-- D' Box --- ------ Type F;Ifier Material - -----Depth Filter Material ------- ------ ------ - s U 6�-r------- Property Line ---�'---------------- pistance to nearest: Well _ _____�_��____ -______- Foundation _.__.___. f �r [ p `� .: Number --- -rRock Filled Yes No .0' SEEPAGE PIT Depth __----�__._ ____ Dia Water Table Depth l- ?a r == Rock Size X / .�� r r Distance to nearest: Wel! ---------- _G_O __-.------Foundation ____ _f1____------ Prop. Line _______________•.----- � REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) r. 4 --------------------------- I Septic Tank (Specify Requirements) ---------------'__ ------------ - Disposal Field (Specify Requirements) ____-_____ ---------------------------------•----------- -------------- ------------------------------------- ----- --------------------------------------------- - ---------------------------- (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 of the.San Joaquin Local Health District. Home owner or liven- County Ordinances, State Laws, and Rules and Regulations sed agents signature certifies the following: "I certify that in the performance.of the work far 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." Signed ------------- -- -_= wne By - e y T;H r _� . (if other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _._ - - ----------- DATE U__.. �-:-- - -_------------ ---- BUILDING PERM-IT ISSUED -------------------------- DATE ---------------------------------- ADDITIONAL COMMENTS ------------- ----- -----------`-- - - - ----------- ---- ---- - ------------ --- --- --------------------------- ------------------ ------- - ---------- ----------------------------------------- :' / ��,( --------- - ------------------------------------------- Final In ection b /" ----- - ---- Date ------- l ----- JOAQUI L CA HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M