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FO's OFF' E USE: APPLICATION FOR SANITATION PERMIT 4 Permit No. -- - - - ----- (Complete in Triplicate) Date Issued --- ....... -------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to th'e 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 and existing Rules and Regulations: - - CENSUS TRACT -------------- -----•----- JOB ADDRESS/LOCATION ��-��-----�- �-�"� - -- ---- -------- ---- - --- ----- - - Owner's Name ------ ---- Phone f AddressIS - - ------------------------------•- City Contractor's Name -------------- -- & SdTC -_________------.License # �� 711------ Phone - --- ------ ------ - Installation will serve: Residencev�Apartment House'M Commercial ❑Trailer Court ',❑ Motel ❑Other .------------------------------------------- i . -. - _ Number of living units:___/-___._Number of bedrooms ____.�,y__- Garbage Grinder _ .__ Lot Size -- -Q---i -- va El Water Supply: Public System and name ----------------------• -- ------- -LI�L�------------------=---Pri to I W, "W Peat Sand Loam ]Cls Loam Character of soil to a depth of 3 feet:.]Sand;0, Silt(] Clay ❑ ❑ Y ❑ Y ❑ I Hardpan ❑ Adobe Fill Material ------------ If yes, type ----------f-------`--------- U i i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.`must +be placed on reverse�sside.) k NEW INSTALLATION: (No septic tank or seepage pit permitted,if public sewer is available wlyhin 200 feet,) I PACKAGE TREATMENT"[ ] SEPTIC T�-------.-- K K. ze__-- -----�-�---- -------------------- Liquid Depth ____-- --------------.----- _ 1 ___ No. Compartments __?- _;-.---:---- �I # Capacity�� Type Material `-i?-�!L _ ' - r Distance to nearest: Well ------------------------------------Foundation ___� ____-_-____-- Prop. Line ___, _____.____-. � Len � � �-A- ---�-- Total""Length ---------0--------'.------ LEACHING LINE No. of�Lines ,---______--_._________ gth�of each line,f_-; - - 'D' Box -----_-___��Type Filter Materiaf•_(��:fil�---- Depth Filter Material __1 ____________ } `Distance t(5-nearest: Well _-__________.________ Foundation ___l0_*-___.___"--- Property Line -5-------------- SEEPAGE PIT , Depth ----`Z-S------- Diameter __ ---- Numljer ---------------------------- Rock Filled Yes No .I] :. Water TableDepth ------------------- ----------,---...-------=---Rock Size X 7r1 i fDistance to nearest: Well __ -- ___------------------------------Foundation __fd--- ------ Prop. Line _-_-__------- REPAIR/ADDI710N(Prev. Sanitation.Permit# ----------- -___ ``'i -----------------------Rate ----------------------------------) : Septic Tank (Specify Requirements) ------------------- ---:- ------------ ..-------------------- ----------------------------------------------------------- --------- I Disposal Field (Specify Requirements) ----------------- ---------- ----------------------- -------- ------------------------------------------------------ -----------------------=-------------------------------------- `# ---------------------- ----------------------------------------------------------------------------------------------------------- y p existing and required addition on reverse side) " - ""--- --------Draw I hereby cern that I have pyre ared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and-Rul'es.and,Regulations of the San Joaquin LocaljHealth 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, 1 shalt not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --- not -- --- ---------- Owner^-^-`.'"- I ` F title ------ �- Y I ------------------------------------------------ than owner] ' OR DEPARTMENT US ONLY APPLICATION ACCEPTED BY II- _- -_ ------ - -- DATE ----------------------------------- BUILDING PERMIT ISSUED ----------------- DATE ADDITIONAL COMMENTS ---------------------- ----------------=--------•-•----•----------- ----------- ----------------------------------+----------------------------------------------------------- --------------------------------------- ----------------------------------- ----------------I --------------------------------------------------------------- _: - ------------------------------- ------------------ _ --------------- ate-- _ _ Dafie ------- ---- -� ._ Final Inspection bY: --------V ------- SA,N -T--SAN-JOAQUIN°LOCAL HEALTH DISTRICT <57 E. H. 9 1-'68 Rev, 5M