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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _�� Permit No --------- (Complete in Triplicate) �: Date Issued --�------------ --- ----------------------------------------- This Permit Expires 1 Year From ate 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 Na. 549 and existing Rules and Regulations, ---._CENSUS TRACT ----ate-------j --------- � - JOB ADDRESS/LOCATION ---�0T_ q=_ ' _-Phone ------------------------------------ ----------- - Owns Name ------------------ ---------------------- ----------- --------------------------------�p ----- - ------- y�j �t,� --------------------------- City 'A'c ress �� 6_tU ---- _ Phone ------ License I Contractoor's Name ----------- ------ - - - ontrlatwill serve: Residence Apartment House❑ Commercial .[]Trailer Court ',❑ r Motel ❑Other ----------------------------------------•-- Number of living units:___ yy Garbage Grinder Lot Size ------------- ---- -- ! sa!____ Number of bedrooms ____ ______ - Public System and name --------------------------------•-- ---- ---------------------------------- -----------------Private^�' Water Supply: Y Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam I y e ------°------- ------------- Hardpan ❑ Adobe'❑ Fill Material ______- -_-- If es,type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must Ybe placed on reverse side.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �= ! id Depth -- PACKAGE TREATMENT SEPTIC TANK�� Size Liqu i`7Z6� Materia!- ----------------- No. Compartments ---�---•-----�.... Capacity 199- _--- Type 6 -- ' Foundation ---jam--- Prop. Line __ --=---•- Distance to nearest: Well _______ _ -------- - --- ---- - - �a-- --- ----- Total Length -----`�-----��--•-----••---- LEACHING LINE [�" No. o#Lines ------/--------------- Length of each line____._ -___ � �__De Depth Filter Material __-__-7Z----•---------••-----••`._.. 'D' Box ._--�_.- Type Filter Material------- p GG_.�- _":_ Foundation' _-- 1 — Distance to'negresfi:`Wel1 __.J-- - _ X` Biarrr�er�b �` �---- Number ..........Y----------------- Rock Filled Yes le No �❑ SEEPAGE PIT [ ' Depth ` 7------------- y �---� --------------- ----------Rock Size --------------------------- Water Table Depth --------- - - � ------ Distance to nearest: Well -------------------------- --- ------•--Foundation -------------------- Prop. Line ---- r ' Date ----------------------------------) REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- Septic Tank (Specify Requirements) _-------- - --------------------------------------------------------- --------------------------------- irements} ---•-------------- -- - ------------------------------------------------------------------ Disposal Field (Specify Requ ------ -------------- ---- -------------- --------------------------- -------------------- ------------ ---------------- ----------- . (brow existing and required addition on reverse si e I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin I and Regulations of the San Joaquin Local Health District. Home owner or licen- County Ordinances, State Laws, and Rules sed agents signature certifies the following: erson.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 sub'ect to Workman's Compensation ws of California." Owner r Signed ------ - - - - --- ------------------- - ---- -- --------------------- l-'Z ---- ------- -------- ------ Title - ---=------------------------- ------- ---- ------------------- - (If other than owner) FOR DEPARTMENT USE ONL ------------ ------------- -------- DATE c� APPLICATIONACCEPTED ------------------------------------------- ----- l DAT ----------------------------------------•-- BUILDING PERMIT ISSUED ----__------------------------- --- . . -- ---4 - --- -- ------------- ----------- -------- ----- -------- ADDITIONAL COMMENTS --------------------------- --------- ------ - / ------------------- 1. - - - ------- ------ -------------------------------------------------- - --- ------ ------ ------------- ----- ----- --- -- -Date- -`/----- - ----- --I-.--.--.- -- Final Inspection b ------------------- ----------------- - - ---------------- - SAN JOAQUIN LOCAL HEALTH TRIC? E. H. 9 1-'68 Rev. 5M _