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__wFCJ.R,_OFFICE USE: APPLICATION FOR`SANITATION PERMIT ----------------------- Permit No. - �.� [Complete in Triplicate) ------------------- ---- a< -------- ----- P Date Issued ------------------------- --------------- This Permit Expires 1 Year From Date Issued Y' 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 aO�N�S Rules and Regulations: � ,/ ".3 / o -` US TRACT - r JOB ADDRESS/LOCA - Ph Owner's Name 1 ��`v---- - ----- ------------------- - ---------------- one i ' f Address ---------------------- -- -------- - -- ------- City - ✓c�1.._..r License # -- --�� y^ Phone' --'--------------------- Contractor's Name •� ------------ ------------ = Installation will serve: Residence i pgrtment House❑ Commercial []Trailer Court 'El Motel ❑Other"-------------------------------------------- , ! j '_Lo# Si a - � - ------ -- Number of living units:___._!-- Number of bedrooms -""" Garbage Grinder � � , Water Supply: Public System- and name -- --------- ----•----- ---- - ---------- ------------------------------------------------ Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam"-Ej Clay Loam ❑ Y type -------- Hardpan E] Adobe Fill Material _�_-"" if es, pe•_.-g�__.__________ (Plot plan, showing size of lot, location of system in relation 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,) 1/` S e Liquid Depth --- ------------------ f �j PACKAGE TREATMENT [ ] SEPTIC TAN tjl1Z }T------- - Gi f_t?C� No. Com artments "� Capacity -1-�VK Type _Gg_uw�Material_i.�C p f ""� f Pro Line _ _ i Distance to nearest: Well "--150-7-1---------------------- __ ---- p• ---- No. of Liries _c .----------------- Length of each li`e_- �' Total `et1 •----•- LEACHING LINE 1 . r r I D' Box . k Type Filter Material " _�Z_- -"----Depth Filter Material - ------- --- ---------�.ProlppertY Line --- --------• •-;• Distance ;o nearest: Well _""__ ---_------___ Foundation _. ` �-________ Rock Filled Yes No 0 - SEEPAGE PIT [ Depth _. �-------- Diameter 3 r� Number ____._, � x Water Table Depth -----65--- - =----_ ------Rock Size -=-� - --------------------- I _ -----------' 1 3 �- ------- Pro Line - n Distance to nearest: Well -------- __��_-""------------------ Foundation P• ` Date ----------------------------------) REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- I _ _ Septic Tank (specify Requirements) ------- - - -------------------- ---------_ , .------------- I --- --- ---- ----- ---,-- --- -----•--- ----- - f>< Disposal Field (Specify Requirements) 1 ------------- ----------- -------------------------------------------- --- = - ------------------------------------------------------------------------------------------ - - - - = ------- --- ---- f ; (Draw existing and required addition on reverse side} 1 I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin i aquin local Health District. Home owner or licen- County Ordinances, State Laws, and Rules and Regulations of the.San Jo sed agents signature certifies the following: arson in such manner "I certify that in the performancelofthe work for which this permit is issued, I shall not employ any p as to become subject to Workman's Compensation laws of California., Signed --- -------------- ---------------- Owner f .�-------- E r• S Title �.._ 'L ,1- ------ --------- ------ ----------- (If other tha ow er) t OR DEPARTMENT USE ONLY k DATE _.`z_"_ "(�.- - Z } APPLlCATlON ACCEPTED BY _: ------- -------- ----------------------------- ---------------- PUILDING PERMIT COMMENTS -------------------- "t --------- ----- --- __ -�: ------------ ADDITIONAL - _ ATE ------------------------------------- -------------------------------------- ------------------ - ---------------------------------------- ------------ --------------------------- -------Date -�----- -- -- - Y-U Final Inspection by- ------- ------------ ------ __--- f 3/�h� e4- C' -�� , A1C�lIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M'