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ti FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -- ---------- - ----------------------------- •--------------------- (Complete in Triplicate) Date issued -a--- -- p ------------- L This Permit Expires 1 Year From Date slue Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein App is made'in compliance with County Ordinance No. 549 and existing Rules and Regulations: described. This application ` ------------------ CENSUS TRACT -------------------------- JOB ADDRESS/LOC TION _ �� I -- ------------ --- ----Phone ------------ Owner's Name ---- -- --------------------------------- - ----- - - ----- f -- � � City --- ------ ------ --------------------------------------------------- Address --- ------- - - - - ----- Address -------------------- --------------- - ---------------- -------------------------------------- = -License # _--------:- --t-- ------- one --------------- - Contractor's Name -------------------------- ---------- 1 10 Installation will serve: Residence ❑ Apartment House Co 1 mercial []Trailer Courfi Motel ❑Other ----- --------------------1----- ------•--- ber of bedrooms ------------Garbage Grinder ------------ Lot Size ---------------------------------- Number of living units:------------ Num Private ❑ Water Supply: Public System and name -----------------______ `Peat Sandy Loam -[I Clay Loam "El Character of soil to a depth'of 3 feet: Sand'❑ . Silt❑ Clay (] 1 ❑ Hardpan ❑ Adobe:❑ Fill Material ............ if yes,type z of lot, location of system in relation to wells,'buildings., .etc. must be placed on reverse side.) n showing size i {Plot pia g � r ::`�: � - ' (No septicitank oriseepage pit permitted if public sewer is available within 200 feet, NEW INSTALLATION: Size --------- Liquid Depth ------- ---------- SEPTIC TA1Xf ] x PACKAGE TREATMENT [ ] I No. Compartmentsartments ----------------------- Capacity ---.------- CapacrtYv-- -- Type Matera . Foundation ---------------------- Prop Line Distance to nearest: Well ---------------- i I - No. of Lies ------------- -------- Length of••each line----------------- Total Length ----------------• ' LEACHING,LINE [ ] /`�'�- __.-------•-------- ' Depth Filter Material _ -- _ -_---- 'D' Box ` ' _ Type Filter Material ______________ ____ P �S Property Line. ----------------- ------ nearest:nearest: Well ------— �------- Foundation ---------------- lX f a I r Rock Filled Yes '�No I] SEEPAGE PIT [ } Depth _ �6--� Diameter ---------- ---- Number ----- Water Table Depth -- ----------------- - ,.� � Rock Size - ---- Jrd_--- Prop. Line ------------------ - -----------------i---Foundation -------------- ----- p• Distance to nearest: Well _-__-_________'r� , i ------------- ------I Date ----------------- ------ --------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- " _ -----_--"- ' Septic Tank (Specify Requirements) -"_- -------------------- - ----------- --------------- --------------- Disposal Field (Specify Requirements , , 4 f I ----------------- i ---------•---- ------ ! [ ------ required additi®n-or►reverse side) " --- --------------------------------- Draw existing 1 3 e in accordance with San Joaquin I hereby certify that 1 have prepared this application and that the work will be don i County Ordinances, State Laws,rand Rules and Regulations of the San Joaquin Local Health District. Home owner or lieen- sed agents signature certifies the fallowing: erson in such manner I "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to become t to Workm ornpensatiAn of California." : <_-a__ Owner Signed -." - ---I-- �4 --------------------------------- ------------------------ Title -------- - -------------- - of er than ner) FO PARTMENT USE O o _btM_ U1(DATE ---- ---- APPLICATION ACCEPTED BY -._ ---- - BUILDING PERMIT ISSUED --- ZA --------------- - --------- • . ADDITIO L �OMMENTS - ------- -- - a P p f __ ___ = EEK_ _ ----- �'' f /- - -- ----- ------ ��r. __-. 'f/£�r{ s '------- -- -- -------- ------- //A fw - Date ---------- Final inspection by: -------------------------- SAN JOUIN LOCAL HEALTH I; STRICT • - t E. H. 9 1-'68 Rev. 5M �_