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FOR OFFICE USE: APPLICATION FOR. SANITATION PERMIT a �p �f Permit No: ------------ ------ - ° 'y.�r �' (Complete in Triplicrise) " - --- ------------:---------------7-------- ------ ,.--- Date issued This Permit Expires 1 Year Frain Date Issued " ----- 1 .a permit to constrct and Application is hereby made isamadeain comthe Sn pliance ce wi h Counin Local Health ntytrict Ordlnarn,�e No. 549 a d existi g Rulesfialnd Regulations-. described. This application /f 'e --CENSUS TRACT -- ------ �- .. JOB ADDRESS/LOC, ------- C .---- � Phone ---------------------------------- Dwner's Name -- - - �Q- - •- Address l,i ---------, - Y Contractor's Name ------- License # � f" ��Phone .- - 1� Installation will serve: Residenceartment House'D Commercial ❑Trailer,Court ,❑ Motel ❑ Other ------------------------------' ------------ i , Number of living units:__..__f____ Number of bedrooms ----a- Grinder Lot Size - _ -- ------------------ { ' P I to ----- ---- - ------------------------------------- --------------------------;--- - Water Supply: Public System an name ...............�_...-_-__ Clay-Loam Character of soil to a depth of 3 feet: Sand'❑ ' Silt L7 Clay ❑ Peat ❑ 2 Sandy Loom -❑ ❑ f Hardpan ❑ s. Adobe' Fill Materidl .£'__:__ If yes, type ---------------------------- lI , { (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, � PACKAGE TREATMENT [ ] -------•------------ Liquid Depth SEPTIC TANK` ze___ -J I' " No. Compartments ...........Muterici Capacity Type 0 / Distance to nearest: Well ...�,�- ---_-- - ------------Foundation _ � --------- Prop. Line '...• Length of each line ��--�5---- Total Length _�_�-�----•----------- LEACHING LINE [/� No. of Lines _.- s. r r � U I � 'D' Box A .-� Type Filter Materl �Z; --!__ C3epth Filter Material __- - " _ _ --"-- 1 Property Line _.-_ -- Foundation p ty - --., Distance t nearest: Well,_';�---- -- t 1 ._. Diameter' 3 t Number Rock Filled Yes No JQ SEEPAGE PIT ar Depth -a ------- - .. � - - ------: '^ Water Table Depth ---------- -------Rock Size ----f--/ -^- ' , I / �,� Foundation --/6..I----- Prop. Line -- ---------------• Distance' a to nearest: Well -..-_�},---a--4" Date ----------------------------------) REPAIR/ADDITION(Prev. Sanitation Permit s# __-----•-- ` - quirementsl ---------- ------- -' Septic Tank (Specify Re -------------------------------- -------------------------- Disposal :Field (Specify Requirements) - ---------------•"-----------"------------------------------------------- ` .. ---------------------------------------------------------------------------k ------------------.--__-.._...._...._-..-__-..-_..._--.._...�..._.- _... ' ------------------ -- ------------ ------- ------ + -__....,.----------------------------------- ...... ........... .... ......... ................. ._...___-.._.....__-...__.'-_-.___...__-..__.-. l i (Draw existing and required addition on reverse side) _. .-- r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin r County Ordinances, State Laws, and Rules aDistrict. h ome owner or licen- nd Regulations,of the San Joaquin Local Health sed agents signature certifies the following: i i ' "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." � - Signed ----------- - Owner w_ -------------- Title -- (If er t ran FOR .DEPARTMENT USE ONLY DATEzl� .-� l / ----------- APPLICATION ACCEPTED BY ---- - f-- ------ - ----------------- ' ---------------------------------- ---------- -------------.----DATE BUILDING PERMIT ISSUED ---------------------- ------------ ADP� IONAL_C�OMMENTS 'i--^---------------------------- --- ------------ ------/�--� __ --`-�-- ----- --- ----� �--------------------------"------- -------------- ------------------------------- , ----- ------- ------- T - -- --------- ---- r - - - -----.------ --- ----Date _-- a2__ Z - --,- ___ Final Inspection by: w SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 :1 1-'68 Rev. 5M "