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FOR OFFICE USE: ��} APPLICATION FOR SANITATION PERMIT I Permit No. -- - -_- ----7 (Complete in Triplicate) --- . L Phis permit Ex rres 1 Year From bate Issued Date Issued , P 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,m`ade in compliance with County Ordinance No. 549 and existing Rules and Regulations: CENSUS TRACT ---S_"_ ------------- JOB _.-_-- JOB ADDRESS/LOCATION ._ - --5�------- ------------------------------------ x /----- LYS-l�f -�11�- -1 ------------------------------------------ ` ------Phone Owner's Name ______ .�..(j-�— }��f t Address �. 5 - -------------------- --• City `y �'� 4\`-'"- "� - - w ----- -- ---- Contractor s Name -----• -------- ----------------------------- "I,, ---- - _License # ----- - - ------------- Phone ------------------------------ Installation will serve: Residence p rtment Nouse'❑ Commercial : Trailer Court l❑ I BSp i Motel ❑Other ----------------------------------- --- Numbery.of living units:---- -- Number of bedrooms _3-----Garbage Grinder lt��s Lot Size ___JF------_ Water Supply: Public System and name ------------------ ------------------------------------------------ Private [ � Character of soil to a depth of 3 feet: Sand'PT Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ i Hardpan E] 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 Aside.) I ' NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 200 feet,,) r '{ Size--- ____________ Liquid Depth PACKAGE TREATMENT SEPTIC TANK ___---_-- L r [y} C enaapacity ----------- E __ MatTNo Compartments - A -�----�-=�• :_ --------__: .•y Distance to,nearest: Well --------- — - Foundation ---le Prop. Line._-_ -- ----¢--- - Total Length-------- ---------_- •- •. No. of.Lines --- -- - _---------- Length of each line__ y� A r� f 0' I RR�G—ui_A , I D' Box - Type Filter Material /"?4_ <. -Depth Filter Material ____1_F-- --------- ------------- SEEPAGE ---j-- -- ' ` Pro er Line ____ 1 distance to"nearest; Well __-a�__�___�------- Foundation _.��__- ------- p tY ----------••-t SEEPAGE PIT [ ] Depth ----- ----------'-=-- Diameter ---------------� Number ---------------------------- Rock Filled wYes ❑ No i❑ Water Table Depth __ ___Rock Size -- ' Distance to nearest: Well -----------------------------------------•Foundation --------------------- Prop Line __. a REPAIR/ADDITION(Prev. Sanitation Permit C# ---'--------�C.\ ----/------------------- Date ----------------------------------) Septic Tank (Specify Requirements) --------------}------------------------------------------ ------------------------- ------- _ :.-------------•-------------- ------------ Disposal Field (Specify Requirements) -.-.---- � . ---------------------- -- ----------------- -- --- -------------------------------------- ---------------------- - -------- ----------------- ------- --- ---- ------ • - -- ) = = = - Draw existingand required addition- - on-reverse side---- I hereby certify that I have prepared this application and that,the work will be done_in_accordc1 ce with San Joaquin County Ordinances, State Laws, and Rules and Regulations orf the'San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: :. � "I certify at in the performance-of the work for which-this p--ermit is_issued, I shall not\e\ploy any person in such manner ' as to b su ect to Work s Compensation`laws of;California." Sign ----------- --- ---- -1� Owner -------------A ------ Title --------------- ------- Of other,than owner) FOR-.DEPARTMENT_USE,.ONLY. -.- c �-- _ _I'1_�_- E `- �� = DATE ------ _ �� 7 ---------- APPLICATION ACCEPTED BY -_-__--__/_-_ -_- BUILDING PERMIT ISSUED --------------- ---------- -----------DATE -----=-•LL• ---- ----------- -_------- ADDITIONAL COMMENTS ---- -_ ----------------- ------------------------------------------ -- ---------- - - -- ------- ---------------------------------- ------------------------------------------------ -- --- -- - - -------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ ---- ----------------------------------- ------------- -�"�- . _ Final Inspectio - --Date ------ ------ ----- SAN JOAQUIN LOCAL 'HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M