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FOR OFFICE USE: L' APPLICATION FOR SANITATION PERMIT 2---- (Complete Permit No: -_��__frj-D" ��- - r (Complete in Triplicate) - --------� --------- E Date Issued ------------- This Permit Expires Y Year From Date Issued Application is hereby made to the Son Joaquin Local Mealth District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and exi tin es and Regulations: If _ JOB ADDRESS/LOCAT - - - --/ y ---- .-CENSUS TRACT ------------------------ v - Phone of-- �----- ------r�� Owner's Name .� � Address - -��_C----- ---1�2- J-- �------ ------- - _ City --=� - ----------- --- �, - Contractor's Name -----= ------ 02 -' ' License Phone # --- -.- ?'1. ' ' Installation will serve: Residence0'Apartme�nt House❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other ------------------------ ------------------ �' k -- Number of living units:----- Number of bedr ms _�__�/___�Garbage Grinder�f�... Lot Size -___._________-__-__ P. Water Supply: Public System and name '----------�•.c.v-"c_-.{�--------U fC�l ==--------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ ` Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑, Adobe-Z 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.) ` NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) - r PACKAGE TREATMENT [ ] SEPTIC TANK'` Size__k-_�- -f a--- ---------- Liquid Depth ------�---._____,_-.__ Capacity IA.? �-G Vype J6��Material__�Gd+--_ffNo. compartments ___� .�..____ Distance to nearest: Well ____ __ oundation __[---�______-.---- Prop, Line ----!.S_______....-_ a LEACHING LINENo. of Lines _ ___ Length of each line------ --------------- Total Length _/_r _____________ Q' Box ____�---- Type Filter Material � -___,Depth Filter Material ____/ ------------------------•----•- Distance to nearest: Well..-VV-;;�:- Foundation --------- Property Line _._" --------------- SEEPAGE PIT Depth §` Diameter _ -��_ Number _.----__r,0______-----_- Rock Filled Yes;j No j p --!"Pa p Water Table Depth -__- 7 --------- � --------------------•----Rock Size -----s --------------------- ---- -- Distance to nearest-,Well 4,1 __ _-__.Foundation ---ld--------- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ---_ -------------------------Date -- -------_---) ' Septic Tank (Specify Requirements) --- Disposal Field (Specify Requirements) -- "`' -------- ------------------------------------------ --------------- ---------------------------------------------- . ------------------------------- ---------- j ----------------- : 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 shalt not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed -------- ----------------------------------------------------------- -------------------- Owner k BY --- -------------- ---- Title 1 (If other than owner) 1 FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY DATE G'J- � { ---7- ---- BUILDINGPERMIT ISSUED - ---------------------- - ------------ -------------------------------=--------- --DATE ------------------------------------------- ADDITIONAL COMMENTS -------- -------------------------------------------------- ------ /// - = _ ------------ - .------------ `� -------- -------------------------------------------------- A- ------------------------- ------------- Fina! Inspection b Date ---------- --------- -- ---- p Y-- ------ /---- ��_/�_ --- SAN J AQUIN LOCAL HEALTH DISTRICT - j E. H. 9 1-'68 Rev. 5M