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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 Son 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/LOCATION 51CA-S--:------ ---I�-ZIr.C.o------------------ - CENSUS TRACT Owner's Name W-N-------- ------------------------ Phone ��7 �. Addre`ss w s Cit 12A ---------------------------------------------------•--•----- .";•.. ---- License # Phone Contractors Name -- ------ ----- �C ��-------------- --------- Installation will serve: Residence [!<c1rtment House,❑ Commercial :❑Trailer Court l❑ Motel ❑ Other ---------------------------------- --------- Number -------Number of living units------/----- Number of bedrooms ---- --__Garbage Grinder -.-- ---- Lot Size ---------- Water Supply: Public System and name ------------------------------------------------------------ ----------------------------------Private ©r Character of soil to a depth of 3 feet: Sand❑ Silt[] • Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ Hardpan ❑ Adobe Fl*-Fill Material ------------ if yes, type ---------------_----_---__- r (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,) PACKAGE TREATMENT [] SEPTIC`TANK:[c4--_ Size---------------------------- Liquid Depth ------y-i------------- I C3t� C2�_�-.__ Material-CC4'1_0�__ No. Compartments --------------- Capacity ----�� _.�-�-- ----- Type -------- ,: _i Distance!to nearest: Well ------�......................... Foundation ------ -0---------- Prop. Line ------�• -------•-- LEACHING LINE [ ] No. of Lines ------ -- -- Length of each line-------- Total Length ----------•-- 'D' Box = -`Type Filter Material c�----Depth Filter Material ____ --------- �—r Distance to nearest: Well ----- s.7 Foundation ____ Depth Property Line --••-- -- SEEPAGE PIT [ ] ..._ - --- _---- $tertFer -xQ- Number ------------- -- --------- Rock Filled Yes 2— No 0 `. . /a- _Rack Size ___-- ---- ----1 ----�z � Water Table Depth ---------------- - �'; ,^;- ,� -.-, .,� - Distance o nearest: Well ----------------------------•-------_-Fe,f4e en -- -------•--- Prop. Line ----------- ---------- I REPAIR/ADDITION(Prev.'SanitationiPermit# -•---------------- ------------------------- Date ---------------•--------------- -- I •-- Septic Tank (Specify Requitement�s)��----- ----- - --------- -------------- --------------- - ------------------=------ --------------------- --- Disposal Field (SpecifyRequiirementss) ---------------------------•-----------------,---------------------- ---------------------------------------- ------------------------------------w-------------•------- -------- ---- -- --- - - - . - -------------- ----------- {Draw existing and required�ddition 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,4and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify th in the performance of the work for which this,permit is issued, I shall not employ any person in such manner as to bec su ject t orkman's Compensation laws of California." f Signed E 1 #._ Owner I ! . Title --------------- -- -------------------- ------------------------- ------ (If other than owner) " I FOR DEPARXMWT LY // APPLICATION ACCEPTED BY --A------------------------- - DATE _ '/___--L----------- --------- BUILDING PERMIT ISSUED -------- --------------- --- ------- DATE - ADDITIONAL COMMENTS --------- ----------- ---------------- --------------------------- --------•- c, ---- Final Inspection b ------------------------------- ----- ---------- --------------------- ------------------------------------------------ ---- --- ------ ----------- ------ - --- ----------------------------Date - '-/C_.._------------._--------------- --- SAN JOAQUIN LOCAL HE LT DISTRICT co, E. H. 9_� 1-'68 Rev. 5M