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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ��=-�(---`f--- ------------- ---------------------- ----------------- -- (Complete in Triplicate) ------------- -------------------------------------------- - ---------- P ------------------- This Permit Expires 1 Year From Date Issued Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein Regulations- described. This application6is add iri.com li ryyg�v h C nty�OrdindaxnGe �I an�d,gx�sting Rules and Regulations: 12U_l-d /�- r, € :--- CENSUS TRACT --------------- ---------- JOB ADDRESS/LOCATI x -- --- - - Owner's Name ------------------------------------------------------ -Phone --- ---------- - Address ---- ........ /� �"-�`- -- - --- City -/-------- -------- - - Contractor's Name °K-� � License # - Phone . Installation will serve: Residence F] Apartment Hause,❑ Commercial ❑Trailer Court , Motel ❑ Other ------1�_ --- ------- Num ''liv(n units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size --------__-____-____-__-______.__---------- WaterSupply. Public System and name ------------------- -----------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam" Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type _____._._--_.____-.__---- (Pl'ot 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 ailable within 200 feet,) f' SEPTIC TANK Size---------- �� Liquid Depth ------�/�.�-------. C`» PACKAGE TREATMENT [ ] [ ] WW1 Capacity Type - Material �- No. Compartments �--.---•- � Ir � Distance to nearest—Well ------- --------------------Foundation __.�R-----_------ Prop. Line ------- ........... LEACHING LINE [ ] No. of Lines --------- ------ --�-:- Length of each line------.1N-------------- Total Length -----10--------------- �i ♦ - /f 1�' Box ------__- -- Type Filter Material _- - -- -----Depth Filter Material -----I- -------------------- --•---•-- ` ----- Foundation Property Line ------------------------ Distance to nearest: Well��_:_' .- - - ------- ---------------- "°'` �i Rock Filled Yes ] No '0 SEEPAGE PIT [ ] Depth ----- -'¢ _ Diameter - ______ Number -----------I-- - Water Table Depth ----------- - Rock Size , ` Foundation -----f_0-------- Prop. Line ---.�-�-- Distance to.nearest: Well -----__._/_00_______ REPAIR/ADDITION(Prev. Sanitation Permit# -------- {+�-------------------------=----- Date ----------------------------- ----) Septic Tank {Specify Requirements) --`-:-"----- .--- --- -- \n -- - ----------------------- ' ------------------------- W Disposal Field (Specify Requirements) --------- --------------------------------- -------------- --{-------'-- ------ --------------------------------------------------- \n W ;-' Vj -------------------------------------------------- --------------------------------------------- ----------�- ---- -:---_ -------------------------- I- ----- -------•-------------------------------------_k-------------------------------- ------------------------------------------------------------ ------------------------------ - ------------ - (Draw existing and required addition on reverse'side) I hereby certify that I have prepared this app kation and that the work will be done in accordance wilh San Joaquin ► County Ordinances, State Laws, and,Rules and Regulations of the San Joaquin Local Health District. Nome owner or licen- sed agents signature certifies the following: -- C "1 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 becom sublect p Workman's Compensation laws of California." E SignedlL . { - `'-------------------- Owner qTitle --------------� u-'-------- ------------------------ -------- BY {�U .. ` (If fi er than owner) FOR DEPARTMENT USE ONLY E ._ 5 _ ` APPLICATION ACCEPTED BY , DATE __. BUILDING PERMIT ISSUED ------------------------- -------- DATE ------' m.---------- ADDITIONAL COMMENTS -------------- --------- ------------ _ ---------------------- --- ------------------------- --------- --------------------------------------------- -- _ --------- ------------------------ - `. ' - ---- ==----- ---------------------------------------------------- -------------------------------------------------- Final inspection.b : •_ .-� . ----------------------------- - ---------------------- -------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M