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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -- ----- ---------5 ---------- -------- --------------------------- --------- (Complete in Triplicate) ----------------------------------- --------- Date Issued a This Permit Expires 1 Year From Date Issued A lication is hereby made to the San Joaquin_Local Health District forla, permit to construct and install the work' herein described. This application is made in complian�c�e with County Ordinance No. 549 and existing Rules and Regulations: t f JOB ADDRESS/LO ON .amara ---- CENSUS TRACT --------------------------- r - Phone ---------------------------- -------- 7 Owner's Name ----°---- ��rCifiYJ _ P ! -- ---- -- -- hone ' -------------•-----------Addressnse # .Lice Contractor's Name Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court Motel ❑Other -------------------------------------------- Number of living units:-----/.___ Number of bedrooms -------Garbage Grinder ------------ Lot Size -------------------------------------------- = ---------------------------- � Private ----------------- ------•----------"----- Water Supply: Public System and name --------------------- -----------•---- - Character of soil to a depth of 3 feet: Sand❑ ilt fl Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe Fill Material __.___. ----- If es, e , __ ___ buildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, NEW INSTALLATION: (No septicItank or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANK, Size--------------- ------------------•---------•-- Ligf id Depth ---------- PACKAGE TREATMENT [ I [ T e Material---------------------- No. Compartments -------------- Capacity ------------- Yp Distance . o nearest: Well ----- - - ------------------------•_Foundation ------------- - ___- Prop. Line ___a_.'- --------- ----------------------- Length of each line--------------------- ------ Total iLength ----------- -----------•---- LEACHING LINE o'•[�)',,,� � �of Li es 'DBox-_:,, --. ---- Type Filter Material --------------------Depth Filter Material J--------------c - - ---------------•------- --- Property Line - -----•---- ------ Distance.t nearest.arest. Well __ _____________________ Foundation ___------------ -- p tY +` - � --- --------------�- Rock Filled Yes ❑ No i❑ SEEPAGE PIT [ ] Depth --- --------- - --- Diameter �------------ --- Number ------- - , --Rock Size ---------------- --------------- Water Table Depth,---�------=-----------=---=-------------- � Distance to nearest: Well ______________________ __ �:___�,Foundaton Prop. Line ----------• ---------- REPAIR/ADDITION(Prev. Sanitation Permit# ---_---•------------- 6'ate - -----------= -----I g I --� I ------ ---- -- _ -------------------- � f ------ -moi V Septic Tank (SpecifyRe Requirements) - I Disposal Field (SpecifyRequirements) •��- X • � -------------------- ------- - - _,I ��._v.h, - _-_._______ �`-"__�_____T___M__-_________________________________________________________________________________________ I (Draw existing and required addition on reverse si e) I hereby certify that I have prepared this application and that the work will befdonein 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 performances of the work for which this permit is issued, I shall not employ any person in such manner I as to beco subject to Workman's ompensaflon laws of California." ---- ------ ---------------- Owne r Signed -------- ---- :� ---------------• Title -- ------- B T .--___ -- " (If other than owner) FOR DEPARTMENT USE ONLY � f � _ � - APPLICATION ACCEPTED BY __ f ----- DATE BUILDING PERMIT ISSUED - ------------------------------------- -DATE q ADDITIONAL COMMENTS ------------------- -- -------------------------- ------------------------------------ -------------------- ----------- ----------------------------- 1 ------------- ---------------.------- 1 1 -----�-------- --- -- Date-- --------- Final Inspection bY: .� - _- t SAN JOAQUIN LOCAL HEALTH DISTRICT R E. H. 9 1-'68 Rev. 5M