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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT S 7/9Permit No. . --•-• ---•-• (Complete In'Tripllcate) .............................. Date issued This Permit Expires ] Year From Date esus all the work herein Application is hereby made to the San Joaquin Local Health District for a per to construct and inst pp a lication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: . . described. Thi s pp .. .. ....CENSUS TRACT . ....... . ..•---_..... ...._. 1ti JOB ADDRESSAOCATION Phone ........ .......................... ..UiOS.... r ........... Q.&3p...---..12 .: Owner'sName ! _ Address .... Phone ...License Contractor' .... O 1 s Name !-•• �`�� j Installation will serve: Residence j=] Apartment House Commercial ❑TrailerfCourt 0 Motel [@ Other _.. ---- ------ Lot ----- ..... Garbage.Grinder _._._...,.:� Lot Size ...................................... .. {. Number of living units_____________ Number of bedrooms ._.._......_ {y i _Private ❑ ••---•--••--- ---•------•-•- Water Supply: Public System and name _...----•--•---- Silt Clay El -.Peat❑ Sandy Loam .0 Clay Loam C]Character of soil to a depth of 3 feet. Sand❑ ❑ Fill Material .......... If yes,type --..-------•--'---•........ Hardpan C] Adobe-E] f buildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of. system in relation to wells, _ i 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) . . Liquid Depth --•-------- -------------- PACKAGE TREATMENT [ ] SEPTIC TANK T I Size-•-.......................•............. Capacity _....... --..._.--- Type ....-------•- ..... Material_... ' .: No. Compartments ............ ......••• J Go .........Foun dation ----•••--......--•-•-. Prop. Line .............. Distance to nearest: Well .._-- ........... ........ Length of each line._-------- Total length ._....---• , LEACHING LINE [ ] No. of Lines ................ --••--- - D' Box Type Filter Material "t Depth Filter Material _ Line�. -Pro e � ....... - Distance to nearest: Well ........................ f=oundation .-..--.'.------•- i p De th Diameter Number :.-- Rock Filled Yes ❑ No Q SEEPAGE PIT ( ] p -µ l —.---- .__:Rock Size ---- Water Table Depth Foundation t_.... Prop. Line ...................... —'Dista nce to nearest. Well __._____.---•---•--- REPAIRf DITION(Prey. Sanitation Permit# .. ................... .......... Date ) ._. ...•- •-.... 1. __..__.. � ptic Tank jSpecify Requirements) ..-----•-----...--------�•-•- - --;----•�-._......_'_�-.......---•--• ---- j � �i` /told.--./e...._. Disposal Field (Specify Requirements) ........A'..•-A-1 T. ._S._. ' •. r -------- ---- - ----- ........... .. . --�- } {Draw existing and required addition on reverse side) s application and that the work will be done in accordance with San Joaquin hereby certify that i have prepared thi a. . d Regulations Of the San Joaquin Local Health District. Home owner or cen- Cour+ty Ordinances, State Laws, and Rules an 's`ecl agents signature certifies the following: ` ermit is issued, 1 shall not employ any person In such manner l "I certify that in the performance of the work for which this p as to become subject to Workman's Compensation laws of California." rLa °cx......... .:. Owner Signed ._ ..._ .._ -{If oth owner)' ......... ---------------•-...._.._e. Title __..._..._.._.._ ............................. By FOR DEPARTMENT USE ONLY cy - -----•--•_. DATE .�'--�-t...... APPLICATION ACCEPTED BY ...._. ........... .......... DATE _... BUILDING PERMIT ISSUED ......._.................. ••• -•-----------------•--•.........----- = h...:. ..:.._.. ADDITIONAL COMMENTS .............................. -•..... ................. ----.....--•--.•.'...-{ . .. Date .... .% -'.. ..��.•-............. ... Final Inspection by: .._:. .... ._ ....---•••..__..... SAN JOAQUIN LOCAL HEALTH DISTRICT 7172 3 M