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FOR OFIE USE: APPLICATION FOR SANITATION PERMIT - Permit N . �J ------------ o. (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 permit to construct and install the work herein , described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION :--------� �---CENSUS TRACT --------------•-r--�------. Owner's Name ------------------Phone _ - -`_ ---.... Address ------- ©` _?_ -_------ /� .Li,--- j /---------------------------- City _� Cfq�p/ I Contractor's Name --- POrY1- -- .0 '--`SP r --- License # Q �� f ---- Phone / # Installation will serve: Residence XAportment House-❑ Commercial: Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:___ ------ Number of bedrooms*__Q------Garbage Grinder t -------- LotSize,__1q��__.________________________ I Water Supply: Public System and name ----------- -----------------------------------------------------------------------------Private JR Character of soil to a depth of 3 feet: Sand'Z Silt❑ Gay ❑ Peat E] Sandy Loam.-E] t Clay Loam Hardpan ❑ Adobe.-D.—Fill Material___NP-- If yes,type:--------:- - -- k (Plot plan, showing size of lot, location'of system iA relation tow Is, buildings, etc. must be placed on reverse side.) p seepa� it ermitFed if public sewer is avpilable within 200 feet,) NEW INSTALLATION: (No septic tank or �j� ' PACKAGE TREATMENT SEPTIC TANK � Size______ _ Liquid De th Capacity Qo Type -- ---f -- aterial-M -F0 3- No. Compartments _----2x�-...... Distance to nearest. Well a-----------------------------Foundation -----f0----------- Prop. Line ----1_____......-- LEACHINGLINENo. of Lines )_ __ Length of each iine_��_�{_ S_ Total Length __,�Q _______________ 'D' Box NQ---- Type Filter Material _i + --___Depth Filter Material --- -----------•------=•••-------- Distance to nearest: Well __ Q_____________ Foundation __ ------------ Property Line _._,Ie.............. f_ I; SEEPAGE PIT [ ] Depth -------------- ---- biometer ---------------- Number _________-_--------- ❑___-_- Rock Filled Yes No Water Table Depth -- _--_ __ - - ------- ---------------- ---Rock Size -- -------�-------------•• Distance to nearest: Well ______-_____________________________ Foundation --------------------- Prop Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --:-------------------------------) Septic Tank (Specify Requirements) ------------------------------------ --------------------------A---------------------_„,---------------------- ---- DisposalField (Specify Requirements) -------------------------•------------------------------------------------------------------------------------------ --------------- a _ _ (Draw existing and required addition on reverse side) E I hereby certify that I have prepared this application and that work ill be done in accordance with San Ji u 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 Compensation laws of California.” Signed ---R--------- ; --- - _ Owner BY lu ` Title _ � , (If other than owner) s FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ------- ---------------------------------------/-------------------------- DATE ---- ~I ------- -------------- BUILDINGPERMIT ISSUED -------- ----------- ---------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS --------- ----------------------------------------------- --------------- ---------1------------------------------------------------------------------------------------ ---------------- --------------- ----- ----------------- ------------ ------------ ----- --------------------------------- -- --- - - -- ------ --- ------ -------- -- - ----------------------- _ Final Inspectio --- -------- -------------------------------Date p SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M