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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ----------- -------------------------------- ------------------------- ... -- - (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 per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: -CENSUS TRACT --------------------- Phone --7-(07 ----"---1-_--/__� ---� ----- ---- --- -- - ----------------- ---- Name -- ---------------------------------------------- Owner's Phone ! f 7 ` ------- --- - ----------- - Address --------- - _ -ti City - ----------- ---- - ------ t r7 Contractor's Name-n-_ ____ License #6 0T0-}�/=-A - -•J---- - --` '" 1 Installation will serve: Residence)&partment House❑ Commercial ❑Trailer Court i❑ 1 Motel ❑Other __.----------------------------------------- Number of living`units:3'��-- Number of bedrooms _!f-----Garbage Grin r LoOF t Size 72 — ------� 1` --------Private ❑ Water Supply: Public System and name ------------------ -�-------------- -----' � �� Character of soil to a depth of feet: Sand'❑ Silt❑ Clay ❑ Peak t Sand Loam ❑ I Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material __J ,_`:If yes,type --- -------�-------------- • 1 (Plot plan, showing size-of lot-location.of. system�in relation-to wells, buiidings;.etc.-must-be placed on reverse side.) NEW INSTALLATION: (� septic tank or seepage pit permitted,ifi;publi sewer available within 20;`0 feet, l • _ - PACkcGE TRfATYVl1 NT [ SEPTIC TANK' Si�Ze1----_ ' Y' -!>---- --------- Liquid Depth ` =-'--- -=--- ` ` ` ' l { I Capacity ` T e, Y '�` Material__ No- Compartments -----------------. , {- Jrpi Distani I `a to nearest: weif --- -------- ----------------Foundation_-lQ------------- Prop Line --�---- __.•�.-- ` LEACHING LINE No ofiLines Le�ngth'"of each line_-L ------------- Total length ,-2-�_-- a - �� D 1;DV Box -_-- Type Filter Material -- &Ck--Depth Filter Material -.- ------------------�-_-_-- ._ I - Distance ton rest: Well'------------------------ Foundation --6a_"t-------- Property Line �______-...._-- SEEPAGE PIT r' Depth --_ � Diameter_34-_,_� Number ----------�----___--- Rock Filled Yes " No �❑ fi . Water Table Depth - ' - ----- Rock Size J�. ty _- I - -----nearest: Well ---------Foundation Prop. Line _____________________ ` � I ---- R A' (Prev. Sanitation Permit# -------------------------------- ----- Date ----------------------------------) Septic Tank (Specify Requirements) - -------------------- ------------------------------------------------------------- .--------------------------' Disposal Field {Specify Requirements) ---•----------•------------ t ------ -----------------------------------------------•--------------- -------'-- --------------------# -- -- - -t--------------------- ---------------------------- ------------------------ ----------- ------------`--------------- -- ---------- ------------------------------------------ --------------- ------------------- -- --------------------------- --------------------- .•(Draw existing rand�required addition on reverse side) - I hereb`y,certify�jthat,I r I. have prepared this application and"that lthe1work will be Bon in accordance with San Joaquin County Oidinbnces, State Laws; and Rules and Regulations of the,San Joaquin local Health District. Home owner or licen- sed agents signs urea-certifies the following: "1 certify that'in the performance of the work for which this permit is issued, I shall not employ any person in such manasr as to become subject to Workman's Compensation laws of California." 1 • Signed ----- ------- ------------------- ---------------- Owner BY - ice- -"' =Title_'-- '---------------------- -------------------------- + (If other th wner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE -- f'-fQ - 7Q--------------- Qom. 7 BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ----- cr - -- -------------------------------------------------------------------- --- ' ��= k'- A.22 --t_®l� -r` --- ------------------------------------------------------------------------------------------------------ ---- ----------------------------------- ---- - -- ------------------------------------------------------------- --------------------------- ------ ------------------------ -- . ------------------ ----- - Final Inspection by: Date =��=J SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M