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FOR OFFICE USE: APPLICATION FOR,,,SANITATION PERMIT . N. - Permit No. (Complete in Triplicate) i Date Issued ---4___f�1L.. ------------------- ..,________-_----------------- This Permit Expires 1 Year From Date.lssued r Application is hereby made to the San Joaquin Local Health District for a permitto construct and install the work herein I described. This application is made in"compliance with County Ordinance No. 549 and existing Rules and Regulations: i Y JOB ADDRESS/LOCATION .---_-�-- --' -i-----------.OS� �' ---------------------------------'--------------CENSUS7RACT -- ---- ------------------------ Owner's Name r: ,.' � ==_ "`=----------- ------- - - ----- ----Phone --------------------••------- -- -- �. ` Address 7 " City '5 !�/�/��G��'�t e .------------- Ci •--r------------ Contractor's Name _--- � _ �i� ------------- -------------Licen e # , 1_ Phone .---------------------........ a j7 Installation will serve: ResidenceApartment House❑ Commercial❑Trailer Court ;❑ Motel 0 Other ----------- ------------------- f _ i Number of living unit s:_��_____ Number of bed ooms ____. _Garbage Grinder'- -�- Lot Sizegp �__ � -------------- Water Supply: Public System-and-name ___ �f_: _ _ / s�: _ __----_I--------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt L] Clay E] Peat 1:1Spndy Loam ❑ Clay Loam Hardpan ❑ Adobe Fill Material ___________� If yes, type ------___._-:____!_____ r A (P1ot plan, showing size of lot, location of system in relation,to,wells, buildings,..etc..must.be j placed on reverse side.) ,� NEW INSTALLATION: No septic tank or seepage pit permitted if public ewer is available within 200 feet) O PACKAGE TREATMENT I[ ) SEPTIC TANK'[ ] Size----------------�_EE_---------------------------- Uqu d•Depth --------------------------- capacity --- _•----- � MM t – . Capacity ------ ------.-�_.- :Type ----------------- Material=--------------------- No. Compartments ------ Distance to nearest: Welly ------------------ ------------.Foundation ------------------- Prop. Line .--.-.--•----_-- LEACHING LINE [ ) No. of Lines ------------------------ Length of each lineTt----:----------___.__.___ Total.,Length __-___---.-._______________ t r . :D'_Box-"------------ -Type Filter.Material.__----------------`Depth Filter Material --------------------.----------------------- ,� Distance to nearest: Well _______________________ Foundation __._____}'.�______ Property Line. ________..______._._.___ O'SEEPAGE PIT [ ) Depth ____.___- __ Diameter ________________ Numbel-t--------------------------- Rock Filled Yes ❑ No i❑ � 4V Water Table,Depth,'.% _ Rotk Size � Distance to nearest. Well __-____________: �-.....Foundation -- Foundation Prop. Line ...................... `REPAIR/ADDITION(Prev. Sanitation Permit# -__�.�� __------_ ______ Date -----------------------------------I"'""'"`"" Septic Tank (Specify Requirements) --------------- ` =---------------------y ..._ Ing?1113�lsposal Field (Specify Requirements) ----qe_,�12______ __ _ ,(� . I---------------------------------------- I----------------------------------- =', ---- --------------f-----------��- _{Draw existing andl required addition g q dition on reverse side) 1 ]'hereby certify that I have prepared 'this application and that the work will Abe done ire accordance with San Joaquin i Z' County Ordinances, State Laws, and Rules,and Regulations of the San Joaquin Local Health District. Hosie owner or licen- sed agents signature certifies the following:U / 1 certifythat in the r p t performance of the work for whi�h this permit is issued I shall not employ an1►�person in such rnanner as to become subject to Workman's Compensation laws of California." .01 r Signed - Owner s `,� BY - '---------------- `,Title - -- ------------------- (if of an owner) EPARTMENTo-USE ONLY A APPLICATION ACCEPTED BY ------ - DATE —_�'- BUILDING PERMIT ISSUED = -- - -- -------- ---------------------------DATE ------------------------------------------- ADDITIONAL COMME TS __--_. -- = - ------------- - ------- ----------------------- --------------------r----------------------------------- ---------------- --- A: ---- ---- --------- - - ------------------------------------------------------------------------ --------------------------- --- ---------- -- ----------------------------------------------------- --------------------- ------------------------------- ----- FinalInspection by: -------- --- --- -- -- -- ------------------------------------------------------------------------Date `- -- OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M