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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -.---- (Complete in Triplicate) Date issue --------- ---------- ------•- --------- - - --------------------------- ------------------------------_------- �;.. _.. This Permit Expires 1 Year from Date issued _ - Application is hereby made to the San Joaquin Local Health District-forci .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: d i . , �, _ .�... ._.. -.- - N �. CENSUS TRACT - ------------- ---------- - JOB ADDRESS/LOCATION .-- .Phone 1/ ? � Owner's Name r- ----.- City ' �IAddress --------- ---- ---- - 6 ��:}--- - Phone _�G3� - Contractor's Name - _ Commercial:rTrailer Court il- Installation will serve: Residence Apartment House , Motel E]Other ---- ---- --------------------------------- 1. Garbage Grinder - '- Lot Size ---- Number of living units.-- --/ --- Number of bedrooms _ .----- Private Water Supply: Public System and name ------------------`.-- --- Clay Loam w� r. , , Peat❑ -; Sandy Loam .Q Character of soil.to a depth of.3 feet: Sand'C Silt ] Clay e --- ------ _ -_ Hardpan ❑ Adobe 14 Fill Material ____.____-- 1f yes,typ of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (_ t yl {Plotlplan, showing size If ! NEW INSTALLATION: (No septic tank or seepage pit permitfied if public sewer is available within 20d feet, Size------------ ------ --- Liquid Depth ------------ ----------- SEPTIC TANK![ ] "•"------------------ --- " PACKAGE TREATMENT [ ] ' ' Ca acit Type ------------------ __ Mafierial----------------------- Capacity -------------- ----- No. Compartments ------.----------•---- i p Y ---- ---- -------- Prop. Line -------------=•------- 2 Distance•to nearest: Well --------- ------------------ -----•-Founclatibn --------- ----------- ' »,,,, � • _ Totai. Length . Q_..--------- LEACHING LINE N No. of Lines _ Length of each line_.- ----- i r .r D' Box '_ -_l --- TYPe Filter Material -----0- ---- Depth Filter Material _.------ Foundation ------- ° Property Line ---.rte-•0---------•- -- `Distance+to nearest: Well ------- -- No 0 Number - ------ `---------- Rock Filled Yes E ter SEEP PIT [� Depth �. j Rock-Size - - ------------------ �- 4 Water Table Depth - / r Q Prop. Line --- .� Foundation -.-�- -- --: Distance to nearest.',Well,__._�!�- ---- - -- - r- - . Date -------------------------- -------1 REPAIR ADDITION{P ev. Sanitation Permit# ,----------------. T r ; - =---- =-- ---------------------------- -- -- ----------------- - Septic Tan pecify Requirements) f _/Js — �, Disposal Field (Specify Requirements) -------------- - ------------------------------------ ---------- ------ •-----_------ ----------:-------------------- - ------------- ---------- - . x�:-> --- ________________________-____.--_____-_____-_______________ _-____----------------------------- ---------------------------- • ., _ - �-I. . t + 1 (Draw existing and required addition onxreverse`side7 be,d ne in I hereby certify that I have prepared this apaquin plication a osnd tof the San Joaquihat the work wil'n LocaloHealth D strt t Ho eancertow er. oh Son r I ien- t County Ordinances, State Laws, and Rules and Regulat - sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner +' lifornia." as to become subject to Workman's Compensation laws of CO Owner - Signed --------- ---•-- _. ._ BY I (If other than owner) FOR DEPARTMENT USE ONLY i DATE _47-l "'-'�' APPLICATION ACCEPTED BY - --DATE ---------------------------------------- -- BUILDING .�= BUILDING PERMIT ISSUED ------------------------ ------------------------------------------ -- - =------_ _-- ------------------------------- ADDITIONAL COMMENTS _.------ - - - - ------ ----- ----- - ----------------------------------------------------------- -1 ----- ---- ----- ------ .Date �~ '- w Final inspection b ----�-�•�= -- --=--- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT C u o 1_'AR Rev. 5M