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FOR OFFICE USE: " `_ - -- APPLICATION FOR SANITATION PERMIT--------------=------------------------------ 1 Permit No: (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 per to construct and install the work herein described. This application is made in:compliance with County Ordinance No. 549 and existing Rules and SS" ] Regulations. � a .4j.1IATH RO P JOACAION .-__._CENSUS TRACT _____ul_____ ____ _____B Owner's Name 4 Yl1-q------- - - --,4c A- lel ------- ---------- ---- ---------Phone Address -f.�: cr l 1 �'�Z--rl ------ ms--1-------------- City QS----- --------� � --- Contractor's Name --- -- -_-- -- -i -- ---------------------------License #,C.-yp --� Phone --- _` ------- Installation will serve: Residence ❑Apartment House,7 Commercial ❑Trailer Court ;❑ Motel ❑Other ----------------------------------- -------- Number of living units;------------ Number of bedrooms __-________Garbage Grinder --- -------- Lot Size -------------------------------------------- Water ._________---_- _-______________________Water Supply: Public System andlname ___ __ ___--___-__� �_R.O_�____-Private El Character of soil to a depth of 3 fleet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑"'-'Adobe ❑ Fill Material __FS If (Plot plan, showing size sof lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l ' PACKAGE TREATMENT, { ] SEPTIC TANK'[ j Size----_4_ .---- ----K P____------__ Liquid Depth ___15------------- ; Capacity._/,5_-D(_.___ Type _ JZC_ aterial__ Qn(G'! No. Compartments --- ---------- - -- Distance.'to nearest: Well --------------------- Foundation ---------- Prop. Line ------------- --- - LEACHING LINE No. of Lines _____ � � $ C ] ------------- Length of each line--------- Total Length ----,� Q_ -._..-_---_ 'D' Box/_f��- Type Filter Material !!P�_��.Depth Filter Material __.l9..-- ._-__ ---- .......... �}J Distance to nearest: Well --- � _------- Foundation ,_--- ________ Property Line, ____S________________ SEEPAGE PIT [ ] Depth -_ ------ Diameter ---------------- Number -------- ------------------- Rock Filled Yes ❑ No I❑��4" Water Table Depth ------------ __Rock Size -------------------------------- Distance ------------------Distance to nearest: Well ----------------------------------------Foundation _.------------------ Prop. Line -_-------------_._-- REPAIR./ADDITION(Prev. Sanitation Permit# ------------ Date ----_______.______________....-___) Septic Tank (Specify Requirements) ---------------------------------------------------- /-______________________ I � ! Disposal Field (Specify Requirements) ----- -_-._- _____ .D -------- ------------ Wi��, k MLAT0P: QpV>E1z Q� R �, --'--------------------------------- --- ------ - - - ----- {Draw existing and required addition on reverse side) `v - - --T 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 o W kman's Compensation laws of California." Signed ----- --------------------------1 ---------------•-----------•--- Owner By _____________ _ _-. ____.__-___--_- _---__-_____________-- Title ---------- ------------------------ -------------------------------- (If other than owner) FOR PAitTN4ENT USE ONLY APPLICATION ACCEPTED BY ---T-R__CL------------------------------------------ ------------------------------/. DATE ----,5.- f - _ BUILDING PERMIT ISSUED -------- ©ATE ---------------------------------------- ----------- ADDITIONAL /- ADDITIONAL COMMENTS ---- ' -------------- --- ---- ----------------•----•-------------------------- ------------------------------------=------------- s-- - -- - - - - -- - -- ---- - -- -- ---------- - Final InspJ_ --___---Date -- - ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M