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FOR OFFICE USE: { APPLICATION FOR SANITATION PERMIT -- -2 ` Permit No -- --------- ---------- --.-�:-._.-�•-�- -�_...._ — - ..a.-n-,._--=, . —_....;Complete in-Triplicate} . ._ Is--23 --------- -------. Date Issued �---------- - . This Permit Expires 1 Year From 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 Regulations: ------------------------CENSUS TRACT -------------------- JOB ADDRESS/LOCATIO - -----------Phone ------ Owner's Name ------ ra, .� -- --" - �tY ------- ---------------------------------------------- Address - --------------------------------------•---Address ------ - ------------ ----- -- C - Contractor's Name �� - _.License # __` ,r� cal-- Phone a 15i ,r P Installation will serve. Residence Apartment House❑ Commercial Trailer Court i❑ { Motel ❑Other ------------------------------------ ----- r i Number of living units:_.__": - Number of bedrooms -----41—__Garbage Grinder ------------ Lot Size -----� -------------- Water Supply: Public System and1 Private in , name --------- ------ ---• - • ------------ - Character of soil to a depth of 3 feet: Sand'❑ Silt ElClay ❑ Peat.El Sandy Loam El Clay Loam ❑ i Hardpan ❑ Adobe 1�r- Fill Material `----------- If yes, tYPe ---------------------------- (Prot iplan, showing size of lot, location of system in relation to well buildings, etc. must be placed on reverse side.) NEWfINSTALL"A'TION: `(No septic tank or seepage pit permitted if qublic sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTLC TANK j ] • 'Size--------------- - Liquid Depth ---------------------.-----� r , � '_ Materia[---------------- ---- No. Compartments --------------- ------Ca CaP rt Ir - ---------------=-- Type r - t } Distance to nearest: Well ------------ _--_ __ -_' --_ -- ------ 'Foundation ___._---------------- Prop. Line ____._____--:--.----- i .1 r ' ` LEACHING LINE [A No. of Lines --__ Len th of, each line'_____ _._ - --e-------- Total Length --•-------- { 'D' Box ----/------ TYpejllter Material ------. •----.---Depth Filter Material -----/- -- ---------------- f Distancetonearest..All ---------ei�---------- Foundation ---_-�a-- ------ Property. Line ""�"+ ---=------• � r Rock Filled Yes [ No .� SEEPAGE PIT Depthte-- -��---- Diaieter9.,._---'--_ ,Nurr1 er ____-.,.-- --- F iWdteVr.VableNDsepthr -----------Ql�---------------------Rock Size ---------- Prop! F � r Distanceto nearest: )!Nell _______:��Q--- -------------- Foundation - Prop. Line _.___.REPAIR'��;jo` v. Sanitation Pe mr it,# -------------------- ---------------------- Septic ---------------- Date _________ ----------------------- do = - ---- ------ Septic Tarr` (Spec ify-RegvTrei-e , ----------------------- �3 , - ------ -- - Disposal Field (Specify Requirements) "~ ` � Irl v ------ -- -- ------- - - ir ------------------ ----------------- --- ---------- - -, t ------------- ' -------------------------------------- ---------- A' 1 J7ff *t(Draw existing and required addition on reverse side) , `r I hereby certify that I have prepared this application-, and that the work will be done in accordanie with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents sign�at�ire4rtifies the following: !> 'r "I certify that ";the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." - . Signed Owner , * e ' Title u - __________________ r.. By ----��,-'A ------- ------------------- - ----- --------------- -- - s , (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- _ "-;- -- 1 j . DATE --_---� -------S- - - - - --- ------------------------------ BUILDING PERMIT ISSUED ..................... -- -----------------------•----------------- - -----;-----DATE ----------- ------------ ---------------- ADDITIONAL COMMENTS ------- ----------------------------------------------------------------------------------------,`-------------------- - r =------------------------------ ----------------------- -------------------------------------------------------------------- ---------------- ----------------------------------------- - _ ------------ --- -- ---------------------------- - ---- ----------------"----------------------------------------- ------- ----- ( f Final Ins ection b ______--_-""__---.Date --------------------- P Y ,� SAN JOAQUIN LOCAL HEALTH DISTRICT 4.- E. H. 9 1-'68 Rev. 5M