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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � Permit No: ------------ ------ (Complete in Triplicate) p ------------------------------------------------------------------------ � Date issued ------------------------------- G^ t This Permit Expires 1 Year From Dale issued t to and e work rein Application is hereby made to the S n compliance wiJoaquin Local th County ealth tOrdinarict nce No. 49 and existing Rules tand hRegulat ons: described. This application is'ma p : . .! �> -�I- �Il _L-►APC--�j .P��+�� CENSUS TRACT -------------------- JOB -- -------- -•----------- - --------------- �j JOB ADDRESS/LOCATION ._ ___ Phone ��rr Owner's Name __ --.---- CitY - Address ------------ == - ------ -- ; Contractor's Name ---------------- license # 7' Phone ---------�- installation will serve: Residence y4partme House.❑.Commercial ❑Trailer Court :❑ Motel ❑-Other'----------- Number of living units:_._- 1_ Number of bedrooms __ -"_Garbage Grinder ---- Lot Size ---------------------------- Private B Water Supply: Public System an name ------------ ----------- Character of soil to a depth of 3 feet: Sand❑ Silt 0 Clay E] Peat E] Sandy Loam [1CI ay,Loam y e -------------- ------------- Hardpan E] Adobe� Fill Material ____________ If es,type (Plot`plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) - - ....f NEW INSTALLATION: (No septic tank or seepage pit permi#ted'if public sewer is available within 200 feet,) ` Size Liquid Depth --------------------------- PACKAGE TREATMENT [ SEPTIC TANK'[ ] Capacity i--------- -------- Type --------------- Material---------------------- No. Compartments -----------------= Distance to nearest: Well ----------------------------------- Foundation ---------------` Prop- Line ----------=-- t ---.Total Len-th -----------•-----•---------- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line------ g p' Box --�--- ---- Type Filter Material ---------------- Depth Filter Material �------------------------------•----- t - Foundation --�-------- -- -----'Property Line. ------------•----,----•-• �....�"- ' Distance to nearest. We ------------------------ ` Depth _ Diameter ---------------- Number. -----------`- ---'--------- Rock filled Yes ❑ No 0 SEEPAGE PIT [ ] p --- ---- -- - o ( ✓ i - Water Table Depth =-t---------- - -- -------- -Rock Size �. Distance to nearest: Wel ------------. ____________ -- ------------ Foundation Prop. Line•-----------•--------- l I ------- Date --------- ------------------------) - 1 f REPAIR/ DDITION(Prev. Sanitatiiin Permit# -- -= ------ u tic Tank [Specify Requirements) _--___.___- �� ,Q _ --------------- �� Disp sal Field (Specif a uirements) ___--- a �" 4 r --------------------------------- ------------- 4_>_jW i : r ----- -------------------- = 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 San Joaquin Local Health District. Nome owner or licen- sed agents si nature certifies the folio "'1 certify t at i the performs ce of a ork for which firfCalifornia." spermit is issued, 1 shall not employ any person-in such mannerh l as to b c e ect to WQr ens Yi�an laws Signed -- ---- - --- -��-------- . f Title - ---- -------- - - ---- --- -------------------------- ------------- -- - - - - (If other than owner} FOR DEP itTMENT US NLY iDATE - -_f =_ U--------------------- APPLICATION ACCEPTED BY f ----- ---=------------ DATE -------------- - BUILDING BUILDING PERMIT ISSUED ------- -------------------------------------- ------- -------------- ADDITIONAL COMMENTS ---------------------------------- ----------- --- ----------- - f ---------- -------------------- --------------------------------------- -------------- ---------------------------------------------------- ------ Date _o'�__7------- Final Inspection b ----------------------------------------- SAN JOAQUIN LOCAL HEALTH RiCT E. H. 9 1-'68 Rev. 5M