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FOR OFFICE USE APPLICATIONrFOR SANITATION PERMIT Permit No. S S- �`'� ;G�.,plete in Triplicate? -I--- - Date Issued -_'�.=----=-- --- This Permit Expires 1 Year From Date Issued Application is hereby mad i PP y to the San Joaquin Local Health District for permit to construct and install the work herein described. This applicatiod' is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: -------CENSUS TRACT ------------- Owner's Name JOB ADDRESS/LOCATIO - --- �------- -- - - ��.� --------------------------------------------- ---- , •--- -------- hone -------- -----------•--------- city Address .--9.-03 " - _...------ �� ------ -- License # / C� _ _Phone P � � Contractor's Name _-- -- l Installation will serve: Residence)Q Apartment House❑ Commercial ❑Trailer Court iEl } Motel ❑ Other -------------------------------------------- Number of living units:.__Il------- Number of bedrooms ______Garbage Grinder - Lot Size ________ Wafter Supply: Public System and name _________--_ Private f Character of soil to a depth of 3 feet: Sand'[:] Silt(I Clay F1 Peat E] Sandy Loam [x] Clay Loam Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- Plot plan, showing size iof lot, location of system in relation to wells, buildings, .etc. must be placed on reverse sides) NEW INSTALLATION: (m o septic tank or seepage pit permitted if public sewer is available within 200 feet,) -- ------- Liquid Depth f� ------------"-.-..--------- PACKAGE TREATMENT fi] SEPTIC TANK,[ Size__/_ ___. _-to "-- aterial - No. Com artments �.-.-Ca acit /7 " - it Foundation _,1------------------ Prop. Line S ------"- Distance to nearest: Well ___ - - it ,A�0 Length of eac� fine._---- - -- - ---- Total Length --------------•----•• LEACHING LINE { ] Na. of Lines ------_ - �� - ---- ----- - --- _De Depth Filter aterial __/l"______- ------ ------ 'D' Box __/-------- Type Filter Matenal�""_----- ---- P M �l----•" Distance to nearest; Well "___ r------ Foundation �a----------- Property Line. ___ _______________ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number --------------------- Rock Filled Yes ❑ No Water Table Depth -------------------Rock Size ------------------------ 1h' Foundation ----------=--------- Prop. Line _----------------- Distance to nearest: Well ____-_-------------------------- 'It i REPAIR./ADDITION(Prev. Sanitation Permit# ----------=---------------------------- Date ------------------ ------------) I�. Septic Tank (Specify Requirements) -------- ------------------------------------------ ------------------------- -- g- q� ------ " --------------------------------- Disposal Field (Specify Requirements) -------------------------------------------------------------------------------------- -------- �� .----------------------------------------------- ---- ---------------------------- I� ------ --- --- -------------------------------------------- -------- - - - (Draw existing and required addition on reverse side) I hereby certify that I hcsve 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- 4. r 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." ` Signed ------------------------------ Owner -------------- -------------- B Gid Title _------- --------------- -------------- --- - __________ _ ------ ----- ----- --------------------- (if other thlan owner) II' FOR .DEPAR ENT USE ONLY APPLICATION ACCEPTED B -------- --------------------------------- DATE ----I-- - -..---�------------- BUILDING PERMIT ISSUED --- -- - ---------------- DATE ADDITIONAL - COMMENkS -------------------------------------------------------------------------------------------- ---- ---- - - ------------------------------------ ------------------------------------------------- ------------------- ----------------------------- M --------------------------------------------------- - ---- ------- ----------------------- ----- -- - � - ------- ---- _Date ----- - �_ - --- Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5iM