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FOR OFFICE USE: APPLICATION FOR-SANITATION PERMIT -•-.--------*'•---------------------------- Permit No �( .(Complete in Triplicate)- -- riplicate) - ---�--�- --T— � " p ------- ----------------------------------------------- � Date Issued - -- =---------- ------------------------ I This Permit Ex ires I Year From Date Issued Application is herebymade to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with qu�n+ty ordinance No. 549 and existing Rules and Regulations: f 6 d/� '` - nr� JOB ADDRE55/L TION /0 1 _/0'l o os �Q �'�s-�i" - J � r�� CENSUS TRACT ----'--------------------- S j. I , h --- Phone Owner's Name ._ _---------- �. /J_ I City _ _ Address --------- ------------ SSS ;l s - -------------- Contractor's Name -Ll-- --------- ----- License # �� , Installation will serve': Residence'M%partmerit House❑ Commercial :[]Trailer Court 10 1 I f Motel, Other _.__ t I ;�- v -------------- Nu��ber ofKe-d�ooms of living units:------ Number of a oms __ ----Garbage Grinder -- Lot Size -� - -- I -------------•-------------Private ❑ Water Supply: PubliciSystem and name _ _______- -- Character of soil to a depth of 3 feet Sand Q Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ i Hardpan ❑ Adobe Fill Material,/_----- --- If yes, type ---------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on'reverse side.) NEW INSTALLATION:: (No septic tr ank or seepage pit permitted if public sewer is available within 200 feet,) j TREATMENT [ � SEPTIC TANK Size',---- 's--� --��------------- Liquid Depth __ -__ -.,----- fM"aterlal ___ o. Compartments• __,__..--- - PACKAGE Capacity. - ------.. TYP?f ��f 1 _ 7_7 -----Foundation ---------------------- Prop. Line ---------------------- - -- I Total Len th ! - ---------------- LV 4 Distance to near Wel! Cy � ' __ Length line__ g LEACHING LINE No. of-Linds ------------ 9 Q X-�____-De th Filter Material / 'D' Box ' - -- Type Filter Material .____-,__ __ p el ------- Property Line. ------.:.... I Distan a to nearest: Well --7/- Foundation �------------ p tY �. SEEPAGE PIT,- [ Depth S ------ Diameter 3 �'� Number -----.c -------• Rock Filled Yes. No 0 -4 Rock Size Table Depth -------��- �-----`.-�--•----- I Distance t�� -�---. Prop. Line ; . .-_ Water Tab o nearest: Well -------------------•----- -- Foundation ----- ':1 ----------- Date ---------------- -----------------) • ` REPAIR./ADDITION(Prev. Sanitation Permit°# --------------------------------- 1!t Septic Tank (Specify Requirements) --- ----------------------- ----------------------------------•--------------------------- Disposal Field (Specify Requirements) ------------ ----------------------------'----------------------------- = -------------------------------------- --------------------------=----------------------------- ------------------------------ Draw existing and required ' - ------------------------------------- ------ �--- �------- :.. I (- ------ g q 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 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 become subject to Workman's Compensation laws of California." -. Signed I - _ Owner _ _-i I --------------------- --- Title (If other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ------------ ----------- --- DATE -- ----------• ,�------ ----- -- ------- --- - -- ---------- - BUILDING PERMIT ISSUED DATE __mss 'Y ADDITIONAL COMMENTS --------------------------------- -------------------------- - ------------------------------------------------------ c" - 1 ------------------`--------------------- -- ----------------------- -------------------------------------------------- ------------------------------------<--------------------------------- ----- - ---- >/- FinalInspection b Date ) ' SAN JOAC.lUIN LOCAL HEALTH D15TRICT r� 1. _ E. H. 9 1-'68 Rev. 5M },