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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit - -- ------------- -------------- {Complete in Triplicate} Date Issued -- -------- ------- --- r i' This Permit Expires 1 Year From Date Issue ------------ -- ----------- ------- ------ ------ ; San Joaquin Health District the work Regulations.. ern A-- lication is herebetodein co pliace wih CoutyOrdnana No. 549 and existing Rules and described. This application id - L� CENSUS TRACT --------'-�..�-------- JOB ADDRESS/LOCATION ! ', �rl�'� �^+ -------------- _. - -�-. r '� --- ------ -- - -- ----- Phone --------------------------- -------- I Owner's Name G�l �'c4"�� f-/a�f-�--------------------=------------------------------- / City -�l��1 v ------------------------------------------------ Address --- ------^--------------------------------- Address --------------�r x ---- - ----- /a =— ------------ Contractor's - : - License # �•� �✓ Phone -, �. Name __ __--- + Installation will serve: Residence U?K'Pclrtment House❑ Commercial ❑Trailer Court ❑ i Motel ❑Other --------------------------------------------- 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 Loam '❑ ---------------------------- Hardpan ❑ Adobe❑ Fill Material ------------ If Yes,type (Plot plan, showing size of lot, location of system in relations to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ 7 SEPTIC TANK: ] Size------ ------------------ - -------- --------- Liquid Depth --------- Cap.acct - --- Type -----------=-------- Material---------- -------- - No. Compartments ---Foundation -------- ---------- Prop. Line ---------- ------ Distance to neares : Well --------------------------- 1e Length of each line---------------- Total Length --- ---------------- �4 LEACHING LINE [ ] No. of Lines _________ _ __ __ __ g - -- - Depth Filte Material -------------------------------------------- 'D' Box ------- --- Ty a Filter Material ----------------- ----------- Distance to nearest: We ------------------ Foundation Property Line ----------------• -•--- -- _�.. _ �. T❑. x Depth r� ,� D.iametera------ ;, ____ N.umber ,_--__-.- - -------- L Rock Filled Yes. 7 -a _.. - Water Table Depth, - --- ___Rock Size } Foundat- ---- Prop. Line ---------------------- [ Distance to nearest. ell ----------------------- r " ----------------- Date ------- -----------------------) REPAIR/ADDITION[Prev. Sanitation Permit ------- Septic Tank (Specify Requirements) --------_-- - ----- -------- I1�7�� j/Cd,ems 7 !.± = Disposal Field (Specify Requirements) 15� - -- - . / � - ---------- ------------------ _______ __ _ ----- -- ----- -------------- -------- --- k^ Y-------------- (Draw existing and required addition on reverse side) E I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin t . County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen- t ; 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." �,. ' --------- ---- caner , Signed -------------?er Title ----- _ ------- ----- --- --- ---- ----- --- -- ---------- ----------- (if ------ -- (Iowner) FOR-,DEPARTMENT USE ONLY DATE ` r�---------- ----------------------------- --------- -- �— i APPLICATION ACCEPTED BY --- --�1-�--�`_-`-----------,--- ------ --------DATE ------- --•----- ------- ------------ BUILDING PERMIT ISSUED r ------- ---- ------- ADDITIONAL COMMENTS -.- nfDW-R.---.-DRt+!_ _ ,� f - ' _ _.1? ----------�3�---- -------- ---------- --------------- - - -- - ----------- ----------- -- ---------...-__ Date ._ - --- Final lnspec i ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M y _