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FORo .. �.b iy OFFICE USE: APPLICATION `FOR SANITATION PERMIT Permit No: ---------- - (Complete in Triplicate) �- Date issued -------- -•-- ------------------ , _ This Permit Expires 1 Year From Date Issued b marJe permit to construct and -install the work herein x Application ,s here � to the San Joaquin Local Health District fora p ' ed. This a plication �s':made in compliance with County Ordinance No. 549 and existing Rules and Regulations: described. P �?_A CENSUS TRACT ----- --------- z��• --------------------- JOB ADDRESS/LOCATION 9 • ------ ---- -Phone ---------------- ------------------- Owner's Name -------- ---- - --- ------ --------------- ------ City Zt Address ----------- --------------- - C]j ss��nq�'� -- Phone - • _ _--.License # -pC--f�-- - - Contractor's Name -- - r ir Court Residence Apart ent House,❑ Commercial ❑Trailei❑ Installation will serve: Motel ❑ Other --------- --------- ----------- Loft Size -- -[`/�-`---------------•-•- �_-•-Garbage Grinder - --- ----- �---- Number of living units:--- ------ Number of bedrooms -_- Private ❑ Water Supply: Public System and name --------- Peat❑ Sandy Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 feet: Sand'171 Silt❑ Clay.❑ I Hardpan ❑ Adobe g Fill Material - If Yes, type - -- buildings, etc. must be placed on reverse side.)` I (Plot plan, showing size' of lot, location of system i} relation e m ttedof publie•-sewer is available within-200 feet,) t/\\ NEW INSTALLATION: (No septic tank or seepage p p ¢ - SEPTIC TANK'C 1 --------------------- Size--- ;..= Liquid Depth .-- PACKAGE TREATMENT [ 7 - No. Compartments Capacity ---------------------- ----_ TYRe` Material----------- --- - Distance to nearest: Well Foundation --------------------- Prop. me - i I a Total Length --------- ------------------ LEACHING LINE [ ] No. of Lines --------------------- - Length of each line.--_----_------------ . � -------------------------------------•------ , ------Depth Filter Materia 'D' Box _---------- Type Filter Material ------------- -------- Property Line - ' _ Foundation ---------=- Distance to nearest: Well ----------------------- Rock Filled Yes El No 0 Depth Diameter Number ---------- --- SEEPP`GE PIT C 1. Watel able Depth - --- --------------------- -------------------------------- Rock Size ' Prop. Line ---------------- Distal --- _ Foundation =.,-----�-- ------ - Distance to nearest: We ----------------------------------- if ----- --------- Date -------------- ------------ REPAIR/ADDITION(Prev. Sanitation Permit# -=---- 4 Septic Tank (Specify Requirements) ---------- _-_--------- -------------------------------------------- Disposal Field (Specify Requirements -_.---- ------------ -------------------- -------------------------------------------------------------------- - - - - I (Draw existing and required addition on reverse side) t I hereby certify that 1 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. Florae owner or licen- sed agents signature certifies the following: ermit is issued, I shall not employ any person in such manner "I certify that in the performance of the work for which this p i as to become subject to Workman's Compensation laws of California." Signed -- ------------ ---------------- ---------- Owner _- -- -------------------- -- Title - hv_ld4�----- ----- - ----- (lf other than owner) ' F R DEPARTMENT USE ONLY DATE -- f1' rT --------------- APPLICATION ACCEPTED B.. = DATE ---------------- BUILDING PERMIT ISSUED -- ----- ----- ---- -;--- ADDITIONAL COMMENTS -',1----------------------------------------------------------- - t ---------- ---------------------------------------------t------------------ ---- --- ----- -------------------------- - ------- ---------------------------------- ---------------------- ------ ------ - - - -- -------- ---------- - - Date Final Inspection by: ------ -------------------------------- - /°.�,� y f,��/ SAN JOAQUIN LOCAL-,.HEALTH DISTRICT .. f E. H. 9 '' 1-'68 Rev. 5M :r: