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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------- ----'---------- ,•------ ------- - - --- ' (Complete in Triplicate) Expires '. Date Issued --------------- This:PermitJoh xp ires 1 Year From Date Issued Application is hereby made to the San Joaquin LocHealth District for a permit to construct and install the work herein described. This application is made in compliance County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATi 1-40--f�-�----- -- -1--=---- - --` --' --'------ - _CENSUS TRACT -------------- ------- PhName .__ �- ----- Phone ------------------------------------ Address f� ' �- �1 City -- - . '---- �---* - �o.License #�� Phone --------------------- Contractor's Name -------- - -- --'-- ------ ----- -- ------------- ------------ Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ `..:, Motel ❑Other ---------------------- -----------------•--- t -+ I" aw a Number of living units: .... Number of bedrooms �-____Garbage Grinder_____... Lot Size ____�- -- =-_ - --•-Private Water Supply: Public System and name '-�-------------------------------------- - ---------- Character of soil to a depth of 3 feet:,, Sand[] Silt❑ Clay ❑ Peat❑ Sandy Loam Clay )oam ❑ . Hardpan ❑ Adobe ❑ Fill Material ------------ if yes, type ----------------------- ---- (Plot+,plan, sowing gie,o lot, local ion of system in relation to wells, buildings, .etc. must be placed on reverse side.) ` NEW INSTALLATION:a l�(No septic tank or seep a pit permitted ifublic sewer is available within 200 feet,) PACKAGE —f-1 SEPTIC TANK � ��'--6ize_�-.�i�-�r --_�--� -�--------- Liquid Depfih _.�---_•-------------- � Capacity --1 -- - _ Type _ -_-------- Material `--G e. No. Compartm ents ----- ...-•--- i [,!Op---__-- Foundation ------- -----ld-_---------- Prop line stance to neare Well _ _...-----••--_----•--- LEACH[ 'G LINE I [ No. of Lines ------ _` ---- Lengthof-each line----4?0__f_____________ Total Length - '----•--•---- �/ � ✓ ` Q' Box .._. .---- Type Filtdr`:MQterial !4 ---------Depth Filter Material -------- _ _________________-..,-_.__---- V/ y/ i i ! Distance t nearest: Well _. � Foundation -------1_�-_--------- Property Ifine __�_•__________ SEEPAGE PIT ✓[ I V f Depth ---------------- -- Diameter ---�_ Number ---------------------------- Rock Fille Yes ❑ No � E � Water Table Depth ---- --------------�- -----------------•-----Rock Size -------------------------------- , t Distance to nearest: Well --------------1--------------------------Foundation -------------------- Prop. Line -----------_- ------ �a► REPAIR/ADDITION(Prev. Sanitation Permit# ____.-_----- ------------ --Date-_--•________.__...---- -_--- __-} ;`^ Septic Tank (Specify Requirements) ------------- ---------- --------------------------------------- ------- r _ ------------------------ - Disposal Field (Specify Requirements) ---------------------------• -------------------------------------------------------------------- I :: ------------------------------------------------------------------------------------------------------------------------------------------------------------- i -- ------------------------ - 3 -------------------------- --------------------- ------------------------------------------------------- ------------- `-------------------------- (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. HomeYowner 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 beco u ject to Workman' 7ensation laws of California." Signed ------ - --- -------------- Owner By D Title _ --CMS .._f_ - ---- ------ ------------ a (If other than owner) � b' FOR DEPARTMENT USE ONLY [ = == ------- ------------- DATE __ = '� __ __ _____ _ __ ____ BUILDING PERMIT ISSUED -------------------------------- ------- --------------------------------------DATE APPLICATION ACCEPTED BY ./ ADDITIONALCOMMENTS ----- ---------------------------------------------------- ---------------------------------------------------------------------- --------------------------- ---------------------------------------------------- -------------------------------------------- ---------------------------------------------------------------------------------------- ------ ------- - --- -------------------------------- ------ ------- --------------- - ---- ------------------- ---------- _ - Final Inspection by: _ Date _ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.