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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ------------------------------------------------ ----------------- -------------- - (Complete in Triplicate) ----------- ------------------------ -_ -.-.-'�� This Permit Expires 1 Year From Date Issued 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: I JOB ADDRESS/LO ION ._ -_ -----" -- CENSUS TRACT __-5- __.__-- ?'� f ' -------Phone------------------------------------- Owner's Name --- -- Address . d /! `�-� °' ---• City ---- -- ----------------------------------------------------- --•------ 7 ------ - --- - ------- ------------ Contractor's Name ----- - ------- -------- ------ - -- !� _.License # 31p Phone ------------------------------ Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ;l] Motel ❑Other^--- -------------------------------------- Number of living units ----- Number of bedrooms --_-.Garbage Grinder ------------ Lot Size ........ gy=p--- ---•-----• r ------- Private --------- Water Supply: Public System and name ---------------'''-='-- --�- ----- ----- ` 5 Character of soil to a depth of 3 feet: ',Scind'❑ ilt❑ :Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ ' Hardpan Adobe ❑ 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.) NEW INSTALLATION: (No septic,tank or see ge pit permitted if ublic sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK'[ Size ------- Liquid Depth __ ------------------ Ca Capacity 1 �fTe Material----------------- -- No. Compartments -- ------ ---- `p Y ' : ----� ! ----' Yp - Distance to nearest:f Well -___- Foundation --- 1-+?_ -____ Prop. Line -_-s_ _-............ �0 P--------- .14 LEACHING LINE [�/No. of Lines :- �_--------- Length of each line--------- 'D _--.--_ -- ---- dotal Length ,___ __ `' •-- Typ ------ r 'b' Box -___ Type Filter Material _____��.� __Depth Filter Material -____��_- ------------------------------ Distance to nearest: Well ----- 5a-r-------- Foundation ------10---_____---- Property Line --------------------- Z Depth ____-- `r - Diameter __. _ _ _. Number --__-----___ �_.--___- Rock Filled Yes [ No i❑ ; SEEPAGE PIT [� p � 1 Water Table Depth ------------------7b--- -------Rock Size --_ --,[�----//.��---------- 1 l= l'' Pro Line ------ Distance to nearest: Well ----------1- _®__K-------_ Foundation p• ------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _.-__________-.-----_-•------_----) f Septic Tank (Specify Requireme Its) -----------------------------------------------------------------------------------------------------------__-------------------------- Disposal Field (Specify Requirements) ----------- ----------------- - ------------------------------------------------------J--------------------- ----------------------- --------•--------- ---------- ------------------ -------------------------------------------------------------------------------------------------------------------------------- --- 1 (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 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner I as to become subject to Workman's Compensation laws of California." Signed ----------------- v ---cxOwner r BY ------------ --- ------- ----- c ------------- Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __. ----- DATE _ �- - - --------------- BUILDING PERMIT.ISSUED -------- ---------------- ---------- ---DATE ------------- ----•------------------------ ADDITIONALCOMMENTS ---------------------- ------------------------------------------------------------------•--- - i --------------------= --------------------------------------•- - I - ----------------------------------------------------------------------------------------------------------- ------------------------------------- --------------------------- ------ ;0 Final Inspection by: Date ------ -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M /y