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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------- Permit No. .��--�--��v- (complete in Triplicate) Date Issued -"---------- ------- p -------------------------- _ This Permit Expires 1 Year From ate slue Application is hereby made to the San Joaquin Lo Health District fora permit to construct and install the work herein PP lication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: described. This..apP >- r CE TRACT _ ---------•- - NSUS -�----Y- JOS ADDRESS/LOCATION �-- - - -- - --- - ----- -----Phone ---------------------•-----------•-- Owner's Name ---------- --------------•--•-----------•--:. City -=- ---- - --- ---- ----------- ----- -------------------•-----------•-- Address �� --- - - ------ - �3 one --------------------•--------- S ! License #jS ------- Contractor's Name ------- ----- - i ------------------ --------------- installation will serve: Residence [-] Apartment House❑ Commercial Trailer Court El Motel ❑Other - ------ --- - - --- -------- ----------- Number of bedrooms• �....Garbage Grinder Lot Size ---�------------------------ , Number of living units:,^--- j _�, _. Private ❑ , - --------------------------- Water - ---------------- -- Water Supply: Public System and name __ ---------__ - -- ------------------ Peat❑ Sandy Loam Clay Loam ;❑ Silt ;►Clay .❑ ., Character of soil to a depth of 3 feet:' Sand'❑ l� i I e Hardpan ElAdobe ❑ Fill Mayterial _-_--------- If es,typ buildings, etc. must be'placed on reverse side.) }i {phot plan, showing size of lot, location of system i} relation efm fled if public sewer is available wit feet,] NEW INSTALLATION: (No septic tank or seepage p' p �f( 9 . S ----------- Liquid Depth --�----- SEPTIC TANK! � =Size_-,- __"j------� -------�-- ----- PACKAGE TREATMENT [ 7 •••--= T e `-' "' Material_e-� No. Compartments Capacity ' 6 yp Distance to nearest: Well ______-llQ------- Foundation ��--- Prop. Line -. --�-- r a X ---" -- Length of each line-------- ---------- Total Length ,"-- ----• �. r LEACHING LINE No. of Lines ------ ¢ 1' Type Filter Material -----Depth Filter Material ----- - --------- "' '"" ' 'D' Box �----- -- YP 1-6-� . ""-- Property Line ` � Distance to nearest: Weil - --f-U--Cb__'______ Foundation -"----- SEEPAGE PIT [ ] Depth -------------------- Diameter ---- Number ---------- ----------------- Rock Filled Yes ❑ No 0 ' -------•------------------Rack Size -------------------------------- Water - - Water Table Depth --------------------- Pro Line ---------------------- Distance to nearest: Well ------------ -------------------------Foundation -------------------- P• IDate ----------------- ---------------- 0 REPAIR/ADDITION(Prev. Sanitation Permit ----------------------------- I nts)Tank (Specify Requirements) --------------------------- ----------- I ------------------------------------------- Disposal Field (Specify Requirements] ""----------- """--_."___ - - ----- - ------ ----- ------------- --�----------------------------------------- -- ----------------------------- ------------------------------Draw-e aw exi-sting and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in District. Home owner or licen- accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Healt sed agents signature certifies the following: arson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to become subject to Workma ' mpensation laws of California." ----------- ----- Owner Signed ---------------- ---------- -- ---------- - Title --- --- _.. --- -- -- --------------- -------- BY -"---" -"---"--"(1f ocher than owner) FOR .DEPARTMENT USE ONLY � DATE '� "-'_7. -------- APPLICATION ACCEPTED BY - - -- DATE ------------------------------ -- BUILDING PERMIT ISSUED _" ADDITIONAL COMMENTS --------------------------- ---------------•------ ------------------------------------------ ------------------------------------------------------- -------------- ------------------- ------------------ ---------------- --- ---- ' -- --- *--- to a - - --- ---- --- - - - ---------------------------- - - - ----- - - ---------------------------------------- Final Inspection _ SAN JOAQUIN LOCAL HEALTH DISTRICT c w o 1-'68 Rev. 5M --