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FOR OFFICE USE: )tP APPLICATION COR SANITATION PERMIT' Permit No. � ---- l - " -- (Complete in Triplicate) Date Issued �71_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: ----------------------------- -----CENSUS TRACT -------------------- JOB ADDRESS/LOCATION ----" Owner's Name -- "FVR_ - Cz city Address _- / " = Phone ------ r ---.License #�??SSS i Contractor's Name -. ��""--"� I Installation will serve: Residence-AApartmenfi House-E] ❑ Commercial,: Trailer Court i N,. Motel ❑ Other ------------- ----------- ----------------- r� --- Number of living units:--.I------ um ber of bedrooms "asp---"Garbage Grinder (1-- Lot Size Private ❑ Water Supply. Public System and name ------------ ------------ Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat❑ Sandy Loam ElClay Loam ❑ P i - } Hardpan ❑ Adobe'iK Fill Material ---_-__---- if yes,type k ed on reverse side.) (plot plan, showing size of lot, location iof system in relation to wells, buildings`aetcilable w. must be plat et, ) O NEW INSTALLATION: {No septic tank or seepage pit permitted if public se er` SEPTIC TANK [ l I i Size--------------- ------------------------ Liquid Depth ------------- PACKAGE ----------- PACKAGE TREATMENT [ ] ----------------------- Capacity. --------------------- Ca acit -- Type -------------------- Material""-_".---------------- No. Compartments P Y: --- Distance,to nearest: Well ---_" - -- --------------- ------ Foundation ---------------------- Prop. Line ---------------------- 1 Len th of each line ------ Total Length ------------------•-- --- ' LEACHING LINE [ } No. of Lines g 'D' Box ---.----- Type Filter Material ------------------- Depth Filter Material ------------ ` Property Line - k Distance to nearest: Well --- -------------------- Foundation "- -------------------- No y Number ----- =---------------- Rock Filled Yes ❑ SEEPAGE PIT [ ] Depth - Diameter _" Rock Size _ ------------------ Water T �. able Depth ------------------------- Distance-to Pro Line to nearest: Well ------ ------ -------------------------Foundation ---------------•---- p• f f ; Date ---------------------------------- REPAIR/ADDITION -- ------- REPAIR/ADDITION(Prey. Sanitation Permit# ----- -- ---- - ---------j- -- -------- -------------------------- �- --------�-------------- � �_ - -/✓,C-�- Septic Tank (SpecifyRequirements) - ----- --------- ------------------- Disposal --• --------------Disposal Field (Specify Requirements) -------- --- ---r---------- ----- "y - k �''•- /. I --------------- - --------------'--------------------------•---- ------------------ - -- --- - - ------------------------ - -------- ------- - - (Draw existing and required addition on reverse side)k will be �. i donne 1 hereby certify that 1 have prepared this applicati utof the San Joaquin Locat eal h District. Horne owner or 1 cen County Ordinances, State Laws,:and Rules and Regulations sed agents signature certifies the following: erson.in such manner i "I certify that-in the performance of the work for which this permit is issued, I steal not employ any p ' as to become subject to Workman's Compensation laws of California." Owner Signed ------------------------ :.t _ ----- ------• Title ------ -- ----- ----- -- --- -- ------ ---------- (If other an ow er) FOR DEPARTMENT USE ONLY DATE " T 1�-------7 ----- APPLICATION ACCEPTED 8Y --- - - DATE .. F BUILDING PERMIT ISSUED --------------------- ADDITIONAL COMMENTS ----------------------------------------------------------------- - - -------------------------------------------------i---------------_--- _ --- ------------ ------------------------------------- ------ -- ------ Dat -------- ----------------------------------------------- - ---------------------- - e � V FinalInspection by- ------ ----- �c � ----------------------------------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT . F. H. 9 1-'68 Rev. 5M f