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FOR OFFICE USE:.. ------------------------------ APPLICATION FOR SANITATION PERMIT --- ---. (Complete in Triplicate} Permit No: - ---- "" --- ------ This Permit Expires 1 Year From Date Issued Date Issued Application is-hereby made to the San Joaquin Local Health District for a describ'e'd. This application is made in complia with County Ordinance No. 549 and existing Rules and Regulations. permit to construct and install the work herein JOB ADDRESS/LOCAT ON13_ d__--- --- ------------- ---------------CENSUS TRACT Owner's Name ._ � -- ---�-- ------`- -=-�---� --•-i -�-�--------- ------------•-- Address �© f---Z'-� -----' --.Phone._ f---C1--.•.--;�_� _ Cir ------ Contractor'/ame _ - aF - -------C ---------------------- ---- --- ----------License # Phone Installation will serve: Residence []Apartment House❑ Commercial railer Court 3 s Motel F1 Other -- --- --- ------ ------------- -------•- Number of living units------------ Number of be oms _ Water Su PP IY Public System and name -------- Garbage Grinder -__-_-___ Lot Size Character of soil to a depth of 3 feet: Sand' ffPrivate ^+^ ❑ Clay❑ Peat❑ Sandy Loam 0" ""Clay Loam "❑ Hardpan ❑ Adobe ill 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.)• w NEW INSTALLATION: (No septic tank or seepage it d p• permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size" _ r� -------------------- Liquid Depth •-----. W i Capacity. ---- -- --- Type ---------- Material--------------------- No, Compartments _ -- / --1—Distance to nearest: Well _ y Foundation Prop. Line _ LEACHING LINE [ ] No. of Lines - Length of each line---------------------------- Total Length g - ------- x . :. .. D' Bo ----- Type Filter Material ----_- Depth Filter Material -------------------------------------------- Distance to nearest: Well ------------------------ Foundation ___". ""-_-" -------- Property Line ------- SEEPAGE PiT # 'I-,` � F ) Depth ----------------- Diameter -- ------- ----- Number -- ----- ---------------- Rock Filled Yes ❑ No ❑ `` a I Water Table Depth ------------------------------- ------------Rock Size ------ ( Distance to nearest: Well ------------ ----------------E"--------_Foundation ' �. -------------------- Prop. Line --------------.... REPAiRJADDITiON(Prev-Sanitatidn Permit# ------------------ Date ) --------------- Septic Tank'(Specify Requirements) E--------------- - _ _/ ------------ Disposal Field specify Requirements) C _ _ ' --------------------------------------------- ------------------------------------ ------------ - ---- P` S`- ) a ' --- ' (Draw existing and required addition on reverse side) + --------------- ------------------------------------- I hereby certifyrthat 1`have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, andlRules 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 shall not employ any person. in such manner as to become subject to Workman's Compensation laws of California." Signed ., t ------------- i .� .,.- w, ----------------------------------------------------------- Owner BY ------- - ---- , f Title -------- (if other than nerj ---- 44 F PARTMENT USE ONLY APPLICATION ACCEPTED BY _"-._ BUILDING PERMIT .ISSUED "-_]_"- - —Z` ------- --------------�;------:-------------- ----- ��-- ADDiTIONAL COMMENTS = -------- ---------------------------------Z-----------.-----------.--------- -------- . -'--- ----- - _ -- =-=---- -------- ----DATE .- �--- �- ------------- ------------------------- - - -- -------------- - - -- ------- ---------------- - _ ------------- ----------------- ----- ----------------- ----- -------------------- --I--------------------------------------------------------------------- - - -- -- ---- ---------------- ---------------------- -Final inspection b ----------------------------------------- -------- ------------------ Y' ------------- ----------------------------- ateYr- ---------- J QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5