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} FOR OFFICE USE: T t _ _ y APPLICATION FOR SANITATION PERMIT _ , 1 -_ -----=--- - ---_--- -_14,3,). I (Complete in Triplicate) Permit No. ------ his Permit Expires 1 Year From Date Issued Date Issued Appiicatio ishereby4 e to thVS Joaquin Local Health District for p permit tdescribed. This application is -made in compliance with County Ordinance No. 549o oand ex stingnRulesconstrudtalndt Re work he egulgtionsrein j JOB ADDRESS/LOCAT �-- --- G_ `�,, ,fit _ 0�1 ENCS SST 4�� Owner's Name ----- --- _'_--_---_ -----•----- - ------ -----Phone ---------------- Address ------- r 1�6 -en= - Cit i Y --- ------- •----•---- Contractor's Name _--__---__ �-License #/IF - - -- -- - -- ---•- --.. •� ---- PhoneInstallation will serve: Residence ❑ ent House[] Commercial:1Trailer Court Motel [].Other -_-___---_-_ Number of AiVing units------------- Number of bedrooms .------------Garbage Grinder ------------ Lot Size --__--_----_-_-_-__.-__ Water Supply: Public System and name _ _-____ ___ ---------------------------•------------- Private 1� Character of soil to a depth of 3 feet: Sand:Q Silt 01--, Clay [i .feat E] Sandy Loam Ej Clay Loam,0 Hardpan E] Adobe'[] Fill Material ------------ If yes, type ---------------------------- (Plot ------------------ __(Plot plan, showing size of loft, location of system in relation to wells,•buildings, etc. must be placed on r&verse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT I ] SEPTIC TANK ] Size _ - Liquid Depth -------•------------ Capacity ---------------- -- Type -------------------- Material------------e�------ No.. Compartments (! . Distance to nearest: Well ---------------------------- -------:Foundation ----------------------.Prop. Cine -.-------- .--•-___-- LEACHING LINT; [ ] No. of Lines ------------------------ Length of each line------------ ---------------- Total Length ---------.---_ 'D' Box ------------ Type Filter Material --------------------Depth Filter Materia) -----------_------- Distance __________ __ __Distance to nearest: Well --------------------- _ - -- Foundation ---rtf-_-____-----_ ___ Property Line -_. --_ --------•----=-- SEEPAGE PIT [ ] Depth -------------------- Diameter - Number --------,-------------- ---- Rock Filled Yes C) No 1... Water Table Depth -----_-_-'------------------------------------Rock Size`-------------------------------- Distance to nearest: Well --------------------------------- ---Foundation -------------- -- Prop. Line ...................... F REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------- -- Date -- ---------__-_-- ) ----------- Septic Tank (Specify Requirements) Disposal Field (Specify Requirements)1 --- ----------- ----------- ------------------ ----------3-------�['`'` Q ----------------- ----------------------------------------------------------- ---- --- -------------------------------------------------------------------------------------------------- < ----------- -------------- (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 Son 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 x- as to become subject Workman's Compensation laws of California." Signed --- ---- ---------- -►� -- --=------------------ - t Owner - ---------------- BY - ---------------------------- - 11 . i - Title -- other an owner) - ---------------------------- OR .DEPA0TMENT USE ONLY APPLICATION ACCEPTED B z.t-e. - -- - -- ------------ ---------- . DATE j BUILDING PERMIT ISSUED .`� — "---- ----------------- ' 'r " . ------ --------------DATE ---------------------•--------------------- i ADDITIONAL COMMENTS -----=------------------- �• _; - - . .. ,. . - -------------------------------------------------------------------------- t_ a -------------------------------------------------- -- - ------ ------------------------- ---------------------------------- _ ----------jr---------* Inspection b ------ = 7 p y ------ ------- ---.Date � �----- . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M a