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FOR OFFICE USE: + APPLICATION FOR SANITATION PERMIT nn -------- ---------------------------- 3 Permit No. __1_�_-�-J� --�- ------ ------------------------------------------ ��- [Complete in Triplicate) --- ----------------- --------- --- This Permit Expires 1 Year From bate 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 madeiin compliance 'th County Ordinance No. 549 and existing Rules and Regulations: w A---- ------CENSUS TRACT ------------------•------- JOB ADDRE55�LOCATIO _ "" "-- -" rPhone ---------------------------•-------- Owner's Name - --------------------------------------- / ��' Cit ------------------------------------- Address - ------- 1 - -- --- --- Y Contractor's Name ___ � ---- ` License # -- Phone _________"_______ --- ---- k Installation will serve: Res,dence ❑ Apartment House Commercial:❑]Trailer Court ',❑ Motel ❑ Other -__ Number of living units:--- ------ Nuinber of bedrooms __ ---Garbage Grinder ------------ Lot Size ----------------------- --------- Private Le Water Supply: Public System and name ----------------------------------------- ---------------------------- ------------- - ------ Peat❑ Sandy Loam ❑' Clay Loam :lx Character of soil to a depth of 3 feet: ; Sand,❑ Silt❑ Clay F1 Hardpan ❑ Adobe❑ Fill Material ------------ If Yes, type ------------------"" -------- [Plot plan, showing size of loflo�c`ation 'of-system' in relation to wells, buildings, etc. must be placed on reverse side.) _ _ _ . _u p seepage pit permitted if public sewer is available within 200'feet,) NEW INSTALLATION: (No septic flank or PACKAGE TREATMENT [ I SEPTICTANK'� Size-- _---Z-//--�-----.Y��• Liquid Depth ------------------ `` ' No. Compartments .� �.: rw Material - - - --' ---��•-•-------•------- .+ Capacity ��' TYPe §�_ - 1 �., ------------- Distance-to nearest: Well .......... •��---`f-•----•-------Foundation ---- - -- ------ Prop. Line ---.------ f----=--- S No. of Lines ---- ------ Length,of each line------- �------------ Total Length .•.__-�_Wig•-- •--------- LEACHING LINE [� _ Q { `D' $ox,'_ -- Type Filter Material -�-_ ----_Depth filter Material _.____/- ---- ---------------i-------- r____ _��- " -------- - -- Distance to `nearest: We II ____ a---/-------- Foundation -----i.4)------------- Property Line ----------•- Z 1 ''� Rock Filled Yes [ No C SEEPAGE PIT [ p X Diameter _313----- Number __.____-c�------------ De Depth --- `// �. �• Wafter Table Depth --------------/*0------------- -----------Rock Size ---------- f / / Prap. Line __.S-----•---••---7 Distance to nearest: Well ___ ______ h2c), --------------------Foundation Date -------------------------- ------- REPAIR/ADDITION(Prev. Sanitation Permit# --=--- ---------- -- I ------------- }-- ---------------------------- ---------------------------- - Septic Tank (Specify Requirements - -------- ----------------- --------- -w _ ---------- Disposal Field (Specify Requirements) _____________ ------------------------------------ "---"" ----------- --------- -- -- ----------------------------------------------- - - ------------------------------ ----------------------------- ------------------------ ----------------------- - 1 (Draw existing and required addition an 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. 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -- ------------ ---------- ------ Owner -------- --- -------------- ---------- ' Title .-------- ------------ .4- --------------- (!f other than owner) 40 FOR DEPARTMENT USE ONLY DATE ' ---------------------------- --------- ----------- ---------DATE ------- ----------------------------�-l� -�~-�+� --------- .. APPLICATION ACCEPTED BY -- - - ----- - --- -- -- - - BUILDING PERMIT ISSUED - ---------------------------------------------------------------- ---- --------- ------- ------ ADDITIONAL COMMENTS ------------------------------------------------------------ ------------------------------ ----------------------d--_-_---------------------------------------------------------- - --------------------------- ------------------------------------ - ------- ---------------------------- - Date - ---- Final Inspection by- SAN -- - -- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H:-9 1-'j58 Rev. 5M