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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ai� --------------------------------------------------------- iComplete'sn Triplicate) Permit No: ..---------- ----- -------------- - ---------- ----- Date Issued l :_S_" ./ ----- 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: i I +�6� rz� l ��-�-�— __ CENSUS TRACT -------------------------- 4- __ JOB ADDRESS/LOCATION ------------.--_--------------�------- ------ -- ------- -- - ----=- ---------- ---�- - ----- -----�----------- Owner's Name ---------------------Phone - � ---------------------- r^ 5 Sd " ^r4 r _. � Address x Lys- Nr. �J City Contractor's Name --C __-------- --f '--- �i•�� -' I,z� ------- --------License # aZA ,5_A- Phone F Installation will serve. Residence [&Apartment House❑ Commercial :❑Trailer Court i❑' Motel ❑Other r I Number of living units:---- _.--- Number of bedrooms __ -___Garbage Grinder ---4?5- Lot Size 1 Water Supply.. Public System and name - -----------------------------------------------Private 54 Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Material -------- --- If yes, type ---------------------------- i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 1 i i PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size_15 )U0--A------------------------- Liquid Depth _____ __________...__._ _ ' I1e00 -�, � Material-_C 'No. Compartments - Ca acit Type p - Distance Ito nearest: Well x____�_�P"_�}-------------------Foundation)(_-.fid------------ Prop. Line lr___�---.------ LEACHING LINE [ I No. of Lines -_ ------ Length of each Iine_X-- Total Length Y-#54--_ _____________ 'D' Box _: ---- Type Filter Materialf -Z - P ----- --- ............. Well .__._ L ____-_.� Foundation Depth Filter Material Line i I Distance to nearest: ��-- - ��-'----'-'- SEEPAGE PIT Depth f -- Diameter ___ Number ----------"`--------------- Rock Filled Yes ❑ No i❑ Water Table DepthRock Size -------------------------------- Depth ------------------------------------------------ F . [� Distance to nearest: Well ----_/_+�C�____________________ ___Foundation _/�-___________ Prop. Line ______________.__.-- -----1 � REPAIR/ADDITION(Prev. Sanitatio!n Permit# -------------------------- ----------- Date ____________------------_--- SepticTank (Specify Requirements) ------------------------------------ ---------------------------------------- ---------------------------------------------------- --------- Disposal Field (Specify Requirements) --------------- - ---------------------------------------------------------------------------------------- --------------- ------------- ----------------------- -------------- ------------------------------------------------------ --- --------------------------------------------------- ----------------- I - -------- ---- -- - - - - ------- (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 I 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 as to beco ubie t to Workman's Compe sation laws of Colifo nia." Signe C r BYE` `""' Title ------------- ---------------- --- (If other than ovJn f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --- --- ----------------------------------------------------------------------- ---------------------- DATE ----------------- BUILDINGPERMIT ISSUED .------ l------------------------------------------------------- -------------- DATE ADDITIONALCOMMENTS ----------I- --------------------- ------------------------------------------ ------------------------------------ -----------I-------------------------------- ---------------------- -------------------------------I - -------•-------------------------------- r --------------------- -------------------------- f --------------- ----------------------------------------- ----------------------------------------- ------------- i ----- -- Final Inspection b F! - --------------------Date --T ------ ---------- P Y- ----------- k SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M