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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. -------- ---------------------- -------------- - -------- This Permit Expires 1 Year From Date Issued Date Issued p, �T� - 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: JOB ADDRESS/LOCATON � e---- ___/ _�'7x�12E/1cQrve - 4tENSUS TRACT --5--------------------- Owner's Name ------ , ----------Phone ------ Address ------ �� Cit - --- ---- --------- -- i---- - ------------ -- ------- -- Y - .---------- ----------------------- -- Contractor's Name .- ,t ?---- ------ -------License # &Z-3 'fPhone ------------------------------ Installation will serve: Reside ce rV1 Apartment House,❑ Commercial ❑Trailer Court ;❑ b Motel ❑ Other --------------------------- Number of living units:----J------ Number of bedrooms --?------Garbage Grinder ------------ tot Size ---_--_-.---_---------------------------- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------- ----Private �J Character of soil to a depth of 3 feet: Sandf-] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam :❑ 1 O Hardpan ❑ Adobe.00 Fill Material ------------ If yes, type ----------------_---_---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) N NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is-available within 200 feet,) PACKAGE TREATMENT r 'll �-------------------- Capacity / " SEPT C TANK Size �� X -D--- ----,-12------------------ Liquid Depth -----T-- "----- ----- � I Capacity _p ---.-_--- Type__- Material No. Compartments _---- _......... Distance to nearest: Well -------------- ---_--lD---------- prop, Line ---------------y...._ r LEACHING LINE [ J No. of Lines -------- ---------- Length of each line---------[00--(----__ Total Length ---- - --a......-... J� { ,�1 fP � S - 'D' Box --_-"!.- Type Filter Material -------5, 3,---Depth Filter Material ------f- ------------------------------- - Distance to nearest: Well --,5-V---'----------- Foundation_-----/(b-------------- Property Line -----`f^�---.-.-.--- i SEEPAGE PIT 1] Depth -- p7 ------- Diameter --- ��__ Number -_--------,?_--------__ Rock Filled Yes [ No ❑ i Water Table DepthN) 'D Size ' Distance to nearest: Well -------------1 )�__�---------____--Foundation -----f-C_------------- Prop. Eine ---------------------- REPAIR/ADDITION .- •/-_-----REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----------.------- Septic Tank (Specify Requirements) ---------------------------------------------------------------- ----------------------------------------------- ----------- Disposal Field {Specify Requirements) -------------------------------------------------------------------------- -------------------` --------------------------------- -------------------------------------- ------------------------------------------------------------------------------------------- -------------------------------- ------------------------------------- -------------- ---------------------------- ------------------------------------- -------------------------------------------------- -------------------------------------------------------------------- (Draw existing and required addition on reverse side) 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 "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 become subject t #rkman's Compensation laws of California." i Signed --------------------- - '' Owner BY f Yi-F = °`w`L.' e------ Title -- ( s[� 1�f_P_ =- (If other than owner) ? s -FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...` DATE 1- / '7- '" BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------- --------------DATE ------'--------------------------- ---- ADDITIONALCOMMENTS -- -------------------------------------------------------------------------------------------------------------------------------- -------------------------=- ------------------------------------------- - ------- - --- - - ---------- ------------------------------------------ ----------------- -------- Final Inspection by: ---------- Dater- - '' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M 1'