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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---"-"----------------------------•- ------------------- (Complete in Triplicate) --------=----------------------------------- ----------- Date Issued This Permit Expires 1 Year From Date Issued 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 and existing Rules and Regulations: r 7� -------------------- 1�'Q CENSUS TRACT __ -- i JOB ADDRESS/LOCCATD�_3_ !�_ a# jj Z �� J/ ' `� - 1� CJ � �-- -------------��------�---------- Phone / � Owner's Name __- " - Address _ Cal�-- - � -�---�--�-=•------- ---- -- -f--- �---- ----------. Cit ----�- ---- ------------- / S � Contractor's Name ---- -- L � Ac------ -- --- -----.License # -- U �1---- Phone --a----_..-----• -- - ----- ------- Installation will serve: Residence JA'Apartment House❑ Commercial ❑Trailet Court 0 Motel ❑ Other -------------------------------------------- �' F' Lot Size _ -l :f- , -` -�--------- Number of living units:__._.___-__ Number of bedrooms ______Garbage Grinder 21 Water Supply: Public System and name -- __ t Private l Character of soil to a depth of 3 feet: Sand' I Silt o . Clay .❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ ...,,,.,,,_Hardpan ❑ Adobe.E] Fill Material IIf.yes,-type :-__----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) o, NEW INSTALLATION: (;;��PTIC tic tank.or seepage pit permitted if public sewer is available within 200 feet,) O PACKAGE TREATMENT TANK'[ ] r* --------- --------- Liquid Depth -Y- -.- �. Capacity J-6-0-6--- Type�rVFA-6-- Material 1"P6— -G!- _-L--Na. Compartments ----•--•--------•• ) Distance to nearest: We11,_�_ `?-- -------------•---- --Foundation.__f--- ----------- Trap. Line ---` -_-....--------- `'� LEACHING LINE [ ] No. of Lines -_`" L----1:---•-- :Length of each line_ _'_ f� -___-_ Total +Length f- --•••-----•- ^� `� +'r 'D' Box ___� / _De th Fiiter Material -----_-- 1 / -•------•-----------•-• Type Filter Material /G-�-------- p 10_ -_ Property Line �_:-.----------------- Distance to nearest: Well .....� ---------- Foundation _-._ -------- _ __ p rty SEEPAGE PIT Depth Diameter ___ Number ----- --------------- Rock Filled Yes No f❑ Water Table Depth --------...Rock Size -------------------------------- 1 Distance'to nearest: Well ----------------------------------------Foundation ---------------•---- Prop. Line -----------...-------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- I k Septic Tank (Specify Requirements) ----------------- -- ------------------------------ ------------- _•. Disposal Field (Specify Requirements) ----------------------------- ------------------------------------------------------------------------------------------------------------------ k. " _ ,. --- -------- ----------------------------------------------- _: (Draw existing and required addition on reverse sidej I hereby certify that I 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 beco su" t to Werkman's Compensa 'on laws of California." Signed _ Owner By ----- ----- Title - -------------- ----------------- (If other than owner) FOR .DEPARTMENT USE ONLY �--�t-� DATE _-!Q_� S sa APPLICATION ACCEPTED BY ! --------------------------------- -------------------------------------- -- --- BUILDING PERMIT ISSUED -------------- DATE -------.--------------- ------------------- j ADDITIONAL COMMENTS ----- ----------- ------------------------------------------------------------ - -------------------------- f - ------------ -------- --- --- ------ ------ --- ----- ------- ----- -------- -----------------------------------------D /I ";�� --- 4! Final Inspec ' ate L. "----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M