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FOR- OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------- ----------- Permit No. --------------------------------- [Complete in Triplicate? j ------------------------------- Date Issued This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existinRule and Regulations: _ � 0// l SMO CENSDS ,CT ---------------- --------- JOB ADDRESS/LOCATION [.-s?_!. ��O----------- ' �'�s V ✓� -------Phone--------------------------- --------- .Owner's Name ----0r ---� ---------- --------- - -- --- --------- ----•------�� ' / ----------------- ---------------- Address +fP------ rif2_. /Tt _. City Contractor's Namer -------License Phone #� �� - Installation will serve: _ Residence [P'partment House❑ Commercial []Trailer Court ',❑ Motel ❑ Other ------------------------------------------- Garbo /�" e-6� '�-----••---- Number of living units:_______ Number of bedrooms _J7_____Garbage Grinder �__ Lot Size _ ----------------- --------------Private Water Supply: Public System and name ---------------------`-•-- - ---- ------------ --------- - - --------------------- Character of soil 1to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan Adobe ❑ 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,) PACKAGE TREATMENT [ ] SEPTIC TANKSize_-- - - -„q----------------------- Liquid Depth -- ---------.--• �i �.-.-------- Ca --------- Capacity __ �i�_-_-- Type- ___ _- Matenal��/'T�--,_ -- No. Compartments _____ _ p Y �.�`” _-Foundation -- ------------ Prop. Line ------'1 to nearest: Well ___ _ -------------------- ,F Total Len th :_ ._ ----------- LEACHING LINE No. of Lines --.-�------- ----- Length of each line._ ------------- g D' Boxvl:�;_ Type Filter Materia[ !_ Depth Filter Material --------------- f � ---- Foundation -------- ---- PropertyLine ------------------•----- Distance to nearest: Well _._ L _ ___-- � r SEEPAGE PIT Depth __ -- ---- Diameter _ ___-. Number ______________________ _10j_ Rock Filled Yes No >D r _Rock Size Ay Water Table Depth ----- -->� le Distance to nearest: Well __,el - ----------------------Foundation ----7 ---__._.__ Prop. Line ---- ----------- REPAIR/ADDITION REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) -------------------- ------------"_--------------------------- Disposal Field (Specify Requirements) ------------- ----------------------------------------- ---------- -------------------------------------------- -------- ---- -- --- - - - ------------- ----- {Draw existing and required addition on reverse s d e 1 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: "1 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 Comp ation laws of California." Signed Owner ------------------ ---- ----- ------ Title ----- ----------------- -------- ------------------- (1 er than owner) FOR DEPARTMENT USE ONLY 71 OOF APPLICATION ACCEPTED BY _ DATE '- '" - ---------------------- - -- - ----- BUILDING PERMIT ISSUED --- --------------------------------------- DAT ADDITIONAL COMMENTS ------------------------- -------------------------------•------------------- - ----------- ------------------------------------------------------------------------------------------------------------------------------------------------------ -- --_------- --- - -------------- ---------- Final Inspection by: ---Dote`---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M