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F E f s. x FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - - ------- -------------------------------- (Complete in Triplicate) _ _ _ _ _ ---_ p Date Issued ------ This Permit Expires 1 Year From Date Issued e work rein Application is hereby made to the San Joaquin Local ith C unttyHealth trict for a Ord Ordinance No. 549 and existing Rulesrmit to construct and talnd hRegulat ons. described. This application is made in compliant // �' l CENSUS TRACT - � JOB `ADDRESS/LOCAT ON _----- -- ----- --- -- : V . �o 2-S;_ Phone3V--- ----------- Owner's Name , ---------------------- --------------- Address -------• ------ ' -----f-- G�. CItY Address .--------�1- - -. -- . -- ------- � _ - Phone � ,�-- "-`-�------==----- --L;cense # ---- Contractor's Name - --- -- �'=`_"P------ ------'- ----- ------ ------- --- k ResidenceApartmenfi House❑ Commercial ❑Trailer Court ❑ Installation will serve: Motel ❑Other -------------------------------------------- z • [ Number of living units ------ Number of bedrooms -3-------Garbage Grinder ------------ Lot Size -------------- -- --------------------- - I Private --- - ----- Water Supply: Public System and name------------------------ - .E Silt Cla Peat[]_ -Sandy Loam Clay-Lo-an-1-0- 'et: oam-] Character-of-soilao a depth of-3,.feet: Sand'[} ❑ Y ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- (Plot ------------ ---(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.. must be placed on reverse side.)( F Size_ f public sewer is available within 200 feet,) s . NEW IN {No septic tank or seepage pit permitted + � j � i f __A {A SEPTIC TANK [ ] -X ---X- ... ------ Liquid Depth ----------------- PACKAGE TREATMENT [ } I r _- -__ Material ---- No. Compartments --- �-....... Capacity.1-20 4fst: Type • �-a-- --------•-----Foundation ------J-p--r------- Prop. Line --..-:�•---------•- Distance,to near, Well -�,--------- -- � 11 LEACHING LINE No. of Lines - -1 _------ Length of each line..--__ - -_�------_ Total length I-.r _ lip rial ------S---)2----Depth Filter Material -----Zf------- -------- - - sr- / T__.-- D' Box T e=Filter Mate_ r ' Property Line. •---------•---No=•--- Distance to nearest: Well ------ -- Foundation --------1 p Depth -__- Diameter --. Rock Filled Yes ❑ SEEPAGE PIT [ � p -- -=--=--------Number ---•--' -------- ---- - � ---------------- Water Table Depth ---------------------- ----- ----•- ------• Rack Size F Distance2to nearest: Well ------------ - =- -=-= ----Foundation -------------------- Prop. Line ---------------------- I � � .�.-x---•-Date----------------------------------- ) REPAIR/ADDITION(Prev. Sanitation Permit Septic Tank (Specify Requirements) --_------------------------- ---•----------------------------------- A 1 ------------------- --------------------------------------------- --------------------------------------------- -- -- - Disposal Field {Specify Requirements �. = -- - --------------------------- -------------------------------------- ---------------- ----- (Draw existing and_req.uired_ad ition_on_reverse side) I hereby certify that 1 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Owner Signed ------- ------------------------------- 'Title ----- - ------------------------ - (1f other than-owner)-- FOR DEPARTMENT USE ONLY DATE _l0--77�0---`-7 ------ APPLICATION ACCEPTED BY ___ - �. �.✓�� - BUILDING PERMIT ISSUED -------------------------------------- --------------- ------ - DATE - ----------------------------------------- ADDITIONAL COMMENTS ------- ----- ------------------------------------•------------- ---------------- ------------------------------------------ ------------------- ------------ - ---------------------------------------- - -- ------ ---- _ T --- ---- Final ----------- - -----.Dat ��--��-- /-�--�--- Final Inspection by: ---- -- ---- - -�-�'��------ --------- - ---•-------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M