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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. __�-�`---rJ---�-- --------------- -- - ------- -•-------- (Complete in Triplicate) -- -------------------------------- --- -------- ---- Date issued This Permit Expires ] Year From Date Issued __ _____ - (3( - 2-&o -12� Application is hereby made to the San Joaquin Local Health District for a 'permit to construct and install the work herein Applidescrcation s hereby application-is t made)in compliance with County Ordinance No. 549 and existing.Rules and Regulations.. �f f _ /t--�!__�s°r_�--�<�� - '- CE SUS TRACT --------------------------- JOB -- -------- -•-;-----•--- JOB ADDRESS/LOCATION - ' / ^' Owner's Name _ �.�?-' -/------------------------------------- ----------Phone -------------------- --------------- f �? el tJ -4�_ --- City t.�"f Address - ��- �� -------••-� T1� License # -- Phonee' --- ---------- Contractor's Name / Installation will serve: Residence ❑ Apartment House,[] Commercial [_]Trailer Court Motel ❑Other ------------------------------------- Number of living units: ------- Number of bedrooms --1--------Garbage Grinder _/09-_ Lot Size - -- -•----- Water Supply: Public System and name ---------------------------------•-•------ ---- --------------------- ---------- -------- --- -----------__---Private , Character of soil to a depth of 3 feet: Sand;4 Silt❑ Clay ❑ Peat❑ Spndy Loam 0 Clay Loam❑. Hardpan ❑ Adobe❑ � e � laced on reverse side.) 4 Fill Material - - _ If yes, type fi7 e ` n relation to wells, buildings, etc. must be p (Plot plan, showing size of lot, location of system i i NEW INSTALLATION: (No septic tank or seepage pit permitted if public ewer is available within 200 feet_,) f r PACKAGE TREATMENT SEPTIC TANK f---------------- - Liquid Depth -----Z- ----- L-4 �A Material fe' 1------- No. Compartments __ - ---•---------- Capacity -0-0----- Type f��` 4 .� iPropLine l �J•------••- Foundation _�p------ Distance to nearest: Well _l J`�1�----- - n ---- r . LEACHING LINE; ] No. of Lines -�______---------- Length of each line.__- fl¢ Total Length :- -• D' Box ---------------- 1 /b_6Type Filter Material b_6� Depth Filter Material -- ---------- V f # f� f Prop" Line ------- Distance to nearest: Well"____ .P------- -- Foundation __ --- p rty Depth � Diameter ---------------- Number ------ --------------------- Rock Filled Yes ❑ No SEEPAGE PIT [ ] p -- E Water Table Depth Rock Size ---------------- ( I I Foundation Prop. Line ------------- ---•---- Distance to nearest: Well ___________________ REPAIR/ADDITION(Prev. Sanitation Permit# -----___'-____--__-- Date ----------------------------------) Septic Tank (Specify Requirements _ ------------------------ ---------- - -------- •F--------- -- ------------------------------------------------------- Disposal Field (Specify Requirements) ------------------------------------------------ - --------------------------------------------_------------------------------- _------- i r i' (Draw existing and required addition on reverse side) 1 hereby certify that'1 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: "1 certify that in the performance�of the work for which this permit is issued, l shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------- ------- ---- ----------------- ------ - ---- ---------------------- Title /� ------------------------------- ---- - -------------------------- e (I er than ower) FOR D ART E E ON d DATE ---- -- ---------- ---•---------•--------- APPLICATION ACCEPTED BY ------------------------------------ ---- ---- -- -- --------------------------------------- BUILDING PERMIT ISSUED -------------------------------------------------------- ------------------ -------------------- DATE i ------ -- ---------------------------------------------------- ADDITIONAL COMMENTS --------------------------------------- - ------ -- -- ( ------- ----------------------------------------------------------------- -- --------- -------- _ __ ------ --------------------- - --- --- ---- Date - --- --------- - - - - Final - - -- Final Inspection by: ------------------------------------------ - ----- ------ - - SAN JO UIN OCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M