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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---------------- ------------------- -------------------- (Complete in Triplicate) Date Issued = ; __________________ p ---- -------------- ---------------------------------- ---- This Permit Ex fres 1 Year From Date Issued -- Local Health District for a permit to construct and install the work herein Application is hereby made to the San Joaquin described. This application is made,in compliance with County Ordinance No. 549 and existing Rules and Regulations: ' JOB ADDRESS/LOCATION�.. -- - .Glr£ b " -:- --CENSUS TRACT c --------- Owner's Name ------------------------------ Phone _ I Dq ggIry _ Cit ------------------------------- Address Cf _ License # Phone ------------------------------ Contractor's Name _------------------------ - va---------------------------------------- - installation will serve: ` Residence ®'Apartment House[] Commercial❑Trailer Court '❑ k Motel ❑Other -------------------------------------- I Number of living units:_.____-__ Number of bedrooms ___ -__-Garbage Grinder -_0----__ Lot Size -_--&#V-Te --------------- . Private I - - ----------------------------------------------------------------- Oq Water Supply: Public System and name ___________"___________________• --- -- ---- k Character of soil to a depth of 3 feet: Sand'❑ Silt fl Clay [I Peat El Sandy Loam El Clay Loam- "A4"A Hardpan ❑ Adobe LII Material ------------ 1f yes,type ---------------------------- (plot -------- -- ----- --------(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 feet,)seepage pit permitted if public sewer is available within 2DD .) . • PACKAGE TREATMENT ( ] SEPTIC TANK[ Size-- x Liquid Depth -------------- �,� ._______ Material 44� 4----- No. Compartments -- - -------------- Capacity . ------- ------ Type - 0 I � Distance:to nearest: Well ____.�r ate- ----------------- Foundation ___ __,-------- Prop. Line --` a---- �. Q1 �O ,------ LEACHING LINE [ ] No, of L°Ines -------------- Length of each line ---------------- Total Length ,_ _-_- _.-J� " - — D'�Sox *'_ -- Type Filter Material 5_epR--------Depth Filter Material ---_--i- ----------•--- •------ •---- Distance°to nearest: Well ____�d�-- ------ Foundation Rock Filled Yes P - _ _ _ Pro arty me. ---- No SEEPAGE PIT [ ] Depth ------------ --- -------------- ___ Diameter -_ Number ------------------- - - Water Table Depth ------------------------------------------------ Size _____-_--___-___.__-___ ------------------------------------------ - Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --_------_--------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ---------------------------------- Date ----=---------------------------- Septic Tank (Specify Requirements) _.___"_______.____.- -------------------------------------- ------ Disposal Field (Specify Requirements) -_-------- ---------------- -------------- --------" ------------------- P P Y : _ ---------------------------------------- -- l I --- ---------- ------- - (Draw - existing and required addition on reverse side) � I 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 Son 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 becom subje to Workman's Compensation laws of California." Signed ---,�� ® -- ------------ Owner r -------------------- ---------- --------- ------------------------ Tit e --------------------- (If other than owner) FOR DEPARTMENT S NLY ' DATE ---- 0��`l° -------- ----------- APPLICATION ACCEPTED 8Y _---------------- - ------------ ----- -- ---------------- ------ --- ------------------- BUILDING PERMIT ISSUED --------; -------- --•-------. - - --•---- -------- -----•--- --------�..------=-------- ADDITIONALCOMMENTS ------ ---------------------------------- ---------------------------------------- --------------- --�r-�--�----_--------------------- -------------- --------------------------------- -------------------------------------------------------------- ------ ------------------------------------------------------------ ------------- ---------------------------- -----I----------------------------------------------- r --------- • -------------------------- --------- -------- Final Inspection b SAN JOAQUIN LOCAL TH DISTRICT E. H. 9 1-'68 Rev. 5M a.