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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r� --- - ----- - ---- ------------------------ Permit No. - ------------ Date i (Complete in Triplicate) _------------------------ This Permit Expires 1 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: ! d _a � _JOB ADDRESS/LOCATIONS ---- ---------------- -- CENSUS TRACT s Owner's Name ------ _ar----- ------------------------------------------ ------------- -------Phone AddressP r =------- - -------------------- City _ �� ---------------------------------------- License # fd3d'_ __ Phone ------------------- ---------- ---Name . - '44ted.- --�a�"1�- -.-------------------------- i Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer'Court. ❑ k Motel ❑Other ----------- ........... Number of living units:._cR___. r of bedrooms _ 3Garbage Grinder --- _.____._ Lot Size ________-___---____ __ Water Supply: Public System and name ------•---------�1------------------------------------------ ------------- -------------------r-------------------------------------.Private ❑ Character of soil to a depth of 3 feet: Sand Silt Clay 'Peat Sand Loam [� Cla Loam p ❑ ❑ Y "❑` ❑ Y Y ❑ Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type -------------_------------- A (Plot plan, showing size of lot, location'of`system in relatio to wells, buildings, etc. must"be placed on reverse side,l NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE 'TREATMENT SEPTIC TAN Size_ -- °------------------- Liquid Depth --- -------------------- pr,1 { •] " . Capacity l-Qo_ Type _______%Materials_______._ No. Compartments I � �.7 r Distance to nearest:" Well ---� +�- --. -----------------Foundation ---------- Prop. Line ---.S--------- ____-- --- Length of each line._._F'0,_________________ Total Length -- LEACHING LINE ] No. of Lines.--�------ --- g � g - - J 'D' Box Type-Filte`r lvlaterial =_ _-______Depth Filter Material ---------14-------________________________ J1 " Distance to, neare HCl rf�- f Y_ _____'Foundation _:�_.l_12- --_-- Property Line ___�_*.............. L 1 Depth ---- "'Z-f�---_---- D ermeter _�X__�Q_�__ Number -----n-f----------------- Rock Filled Yes E!T"*" No 0 I . , Water Table Depth.- - -----�-�-------------------------------Rock Size --------- ------ -- ----------- ' Distance to nearest: Well------- ----------------Foundation _;_La_` Prop. Line ---- _----___-___-- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----- ` _ Date ._-__________.___------------ --------------=--- I i rSeptic Tank (Specify Requirements) ------------ ------------------- ----=-------------------------- --------------------------------------------•---------------------------- Disposal Field (Specify Requirements) - _----------'-------------=------------------------------------- --------------------------------------------------•--------------- 3 ... hereby certify that I have prepared(Draw s app)cation a d required addition th_____-__-_______________________________________________________ on reverse side) - tha e 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 "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." i Signed -- ------- --- --- - ------------ Owner BY ---------- ---------------------------- Title -- --- ---- - (If other than owner) FOR .DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY ------------- ---------------- . DATE .. I BUILDINGPERMIT ISSUED - --------"--------- ----------------------------------------------- --------------------- ---- -------DATE -=-----"--- ADDITIONALCOMMENTS ---------------------------------------------------------------------- - -------------------------- -------------------:---- --------------------- ----------------- ------------------------------------------------------- -------------- ---------- -----_----_-- ---------_-------- ----------------------------- --------------------------- -- ` - ------- --------- /� Fina! Inspection by: - ------- Date ` ' " -6 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.