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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ----------------- ------- (Complete in Triplicate) Date Issued __ -_-�•--� - ---------------- -•--- - -------------- ---- - - This Permit Expires 1 Year From ateissued - and e work Application is hereby made to the San Joaquin ince w;heCounalth ntytordinance rict for a No. 549 and existing rmit to Rules tand hRegulatonsre;n deser;bed. This application is made in compliance 7odc� ', 9 E S LOCATION l�l� � _y 1��- ��AY--CENSUS TRACT ._ 5� JOB ADDK S / ----Phone --- ------_----- AN ---- Owner's Name -N_ � - 4 `` _ _L _ _ -- ------------------------ City P.Q� 7 Address --- --------- Contractor's Name ___� - - --------------------------------- # _��s�+J`�'_ -- -- Phone ------ --------------- --- ` Installation will serve Residence ❑ Apartment House[] Commercial ,MTrailer Court 0 R : Motel ❑Other __1540-P--- ----------- ----- Lot Size ------ I Number of living units_____________ Number of bedrooms __-__-___-__Garbage Grinder ----------- --------- Private Water Supply: Public System and name -------------------- --- ------ --- -- Peat❑ Sandy Loam •Q 'Clay Loam D Character of soil to a depth of 3 feet: -Sand S;It[:] Clay .� � Hardpan ❑ Adobe'E] Fill Material ------------ If yes,type ---------------------------- ` system in relation to wells, buildings, etc. must be placed on reverse side.) V (Plot plan, showing size of lot, location of y � NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) � 'i Q ' Size- -'K ------------ Liquid Depth---------- --•--•-------- SEPTIC TANK' O PACKAGE TREATMENT [ 7 No. Com artments CapacityC - Type Material__._ - Foundation - ------ -------- Prop. Line __�_ .---:------• istance to nearest: Well _�_ -� ------ ------------- - / // d _s_____________ Length e# each line___`-- Total Length _f--f - -----•-------- LEACHING LINE [ No. of Lines - I -� • _Depth Filter Material .__!_---r�-----------•----------�----------- 'D' Box 1_----- Type Filter Material - DC/'�;-- t � i �trJ Proper Line _l._Q___-------•-•--- Distance to nearest: Well _ _COO---------- Foundation ------------- p ---------- I 1 -'- Number ---------------------------- Rock Filled Yes � No 0SEEP_ ALIT [ � Depth -1-- ------ ------ Diameter -- ------ -- ------- Table Depth ----- ----- ------ ------------------------ - Rock Size -------------------------------- \ Water ---- --------- Pro Line -•---------------- i Distance to nearest: Well ---------------------------------- Foundation p 9 • � ---------------------------------- Date -----------------. •----------------- REPAIR/ADDITION(Prev. Sanitation,Perm�t ---,----:. - Septic Tank (Specify Requirements) ---------------------------- - -------------------------- Disposal Field (Specify Requirements) ____________________________ . ---- ---------------------- ' .. ------ ------ ------------- - r * �_ w" _ -� ------------------------------------------------------------------- {Draw existing and required addition on reverse side) I 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. Horne owner or rcen- sed agents signature certifies the following: "l certify that in the performance f the work for which this permit is issued, I shall not employ any person in such manner as to become ub ct to Workma s Comp ion laws of California." . -:-- Owner Signed ------- ---- -- ----------------- - -------------- - ----- -- Title ---- I ( ther than owner) FOR DEPARTMENT USE ONLY 7 .--Z-_------ . -- - _ __ DATE ----- '--- --•--- APPLICATION ACCEPTED BY l ��r -----=-------------------------------------------------------------- DATE - ------------------- i ---------------------------------------------------------- ---------------- BUILDING PERMIT ISSUED ------------ ADDITIONAL COMMENTS ------- -- ---- - ----------------------- --- - --------- M -- ---------------- - - --------- - - -- ---- --- --- - - - --- - ------ -- --------- —------ ------ ------- --- ------- -- -- - ----- -- .-- - . Date Final inspection y: -= =--- ------ -- k SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M