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FC)FP OFFICEVSE:2- ' APPLICATION-FOR SANITATION PERMIT -- --------------------------- ------------- ---------- - '�, Permit No. = (Complete in Triplicate) .... - -- ----------------------------- ._ :,t ----------------------------------------"---------------- This Permit Expires ] Year From Date Issued Date 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 compliance with County Orrdin h e No. 549 and existing Rules and Regulations: `�/ �.- JOB ADDRESS/LOCATION ____ ______________. CENSUS TRACT ---- -- - Owner's Name -------- ------------b-*1---- �/ -R R -_ ]-- ----- ------------------Phone •------------------- - Address ----- 7� (A// _ A�4'l_ �_ - City ,- --- ----=------------------------- _ _ --- -- Contractor's Name F....JO- -� ------------------------------------ -' i _.License # ......................... Phone •-•-• ............ Installation will serve: Residence 2'�artment House❑ Commercial❑Trailer Court ❑ I Motel ❑ Other ------------------------`-------------------- l p �. - /�C j�J�� Number of living units:_-_ -_____ Number of bedrooms ____:_Garbage Grinder _ __ Lot Size -_,� ____________________-__.__________ � Water Supply: Public System and name.--- ----------- ------•-•- ----------------------------------------------------------------------- ._ -------Private , Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E] Peat E] Sandy Loam .Clay Loam :❑ {%t Hardpan ❑ Adobe ❑ Fill Material Ali_ If yes, type 0Z":,q� (Plot plan, showing size,/Of iot-location-of-system-in--relation to-wells;-buildings,etc---must, be placed on reverse side.) NEW INSTALLATION: No septic tank or seepa pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT!!! ( 1 SEPTIC TANK'[ size____X___)(w_k_ 5 _______________ Liquid Depth ---- f ' _ _ , l,r Capacity l-'9-- Type t�L7RES� Material' Nq�o. ,,Compartments ----.. , istance to nearest: Well -------- ____________________Foundation __.1Q__'____ Pro Line _____ per.:.,------ . LEACHING LIN.E� No. of Lines ------_3- ------ Length of each line_____— t----------- Total Length ----- / --- s /- le 'D' Box -5 Type Filter Material RQ C-il_li..Depth Filter Material --------I.9_____________________________ Distance to nearest: Well ----------- Foundation ---- Property Line, ___ ____-------______ SEEPAG,EPIT [ ] Depth ____________________ Didmeter _______________ Number ---------------------------- Rock Filled Yes ❑ No i]] _. epthw---------------------------------------•--- -- ock-Size-- ----------- --------- Water�Tab�e--q _ Distance to nearest: Well ________________________________________Foundation ------ k------- Prop. Line ...................... REPAIR./ADDITION(Prey. Sanitation .Permit# --------------------------------------------- ----------------------------------------- ;'Date ----------------------- --------- 1 Septic Tank (Specify Requirements', r --? ----------- '4 - �'t I -------------------------------- Disposal Field (Specify Requirements) ----------N_S1 Q�---!- - ------ JQQ0I--------- --OF----------------------- 0 r`H_6F s 7 ' �'� --------------------------------------------._ ` ' S : L (Draw existing and required addition on reverse s de) i ! I hereby certify `that I have prepared,,,this application and that the work will be done in 'accordance with San Joaquin County Ordinan,es,`State Laws, c; ,Rules and Regulations of the San Jnaq�uin Local Health'District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of thew rk for which this permit is issued, I shall not emp y any person in such manner �,�. . . 9 as to b su 746 Workman's Com sat Paws of California." Signed a - Owner { BY ------ ----------'--------- ------------------------ Title --------------- ------------------------- --- - ------------------------ - - (If�0&r than owner) _FOR DEPARTMENT USE ONLY. } APPLICATION ACCEPTED BY t --------- ---. I BUILDING-PERMIT-ISSUED - ----------------------- — ----------- r ADDITIONAL COMMENTS --�` - ----`S-'�� p : {' - .-. -r-------++--.a...- ..�.------------- I---- .�.-------------------------..�.--.-------------.----------- .----w� .+.�..�--------. ---- : #Y Final Inspecfion by- ------------------- Date --- ----�-- -_-- - ----- ------------------- -------------- ------ --- ( SAN JOAQUIN LOCAL HEALTH DISTRICT 4 E. H. 9 1-'68 Rev. 5M