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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - ----------- (Complete in Triplicate) r 3 - Date Issued ------- This Permil Expires l Year From Date Issue e - errnit to ct and e work he �A lication is hereby made to the SanJoaquin compliance Local Health lth DytOrdinance No. 549 d existing Rules fiand hRegulat Regulations described. This application is made P �} �l 'Y WKENSUS TRACT ----- --------------•----- JOB ADDRESS/LOCATIO t-°--_�- 1 -� Phone �----- [ ------------ _' ? Owner's Name - -- ------- z ---- - --------- -------- _ l._-. _Z ----------- Address � F .. one 1 l Ph -X60-7_ (t-s.vJ------ License # Contractor's Name _-.----- ---------- = Installation will serve:+ �esid.ence VApartm.ent House©-C-omme cial ❑Trailer Court Motel F1 Other -------- ---�-� 5 Garbage Grinder _ - -- Lot Size _ ------------------------------------- N - ��---------------- i Number of living units:-- - - - Number of bedrooms __- ____-- 9 --_Private ------------------------------ Water Supply: Public System and name ------------------------------------------------------------- i- i y,t i r A7-; `N _Sa`nd Loam ❑ Clay Loam :❑ Character of soil to a depth of 3 feet: Sand❑ Si1t❑ Clay ❑~ t Pec, Y ------ --- --^-I �es, HardpanAo type --- ----- 1�T �. —buildings;-etc. must be placed on reverse side.) - f rlocat.ion of s stemin gelation to�wells, E' (plot p ian, s owing si e I f"iot,f 1 Y �i NEW INSTALLATION. (No septic tank or seepage pit pe mitted if public sewer is av ilable within 200 feet,) ! - Liquid Depth ------------------- PACKAGE TREATMENT [ ] SEPTIC TANK ] atenal_____-J [ Size _ '� --------- -�_ No. Compartments ------------•----...-- Capacity -------------------- Type ----------------- N --------------------- Pro Line ---•------------------ t FoundationP• Distance to n�ear�e�#:��We11 �-- ---- -- ----------------------- _.__ _. . Total Length ---------------------------- - ----' C 'hof each line----- ---- ------- --- -- LEACHING LINE [ ] N of Lines'------ t_ Dept Filter Material -------------------------------------- ----- 'D' Box -------- -- Type Filterafienal ------------- --- P h � Pro er 'Line ---- Distance-to � :_ oundiatio'n R ty --- ------- ---- ---- - Distance-to nearest: Well -------------- --.� �, F ----------------------- --___--- DiametIr - Number -------------------- Rock Filled Yes ❑ hlo 1[] SEEPAGE PIT [ ] Depth ---- ------- -- Water Table Depth ------- •------ Rock Size - -- - Distance to nwrest: Well _---_ ------------------- - -- ---Foundation -------------------- Prop. Line --------------•------- REPAIR./ADDITION(Prev. Sanitation Permit# ------------ ------------------------------ Date --------------------------------) ------------------------- ------------ ------------ I Septic Tank {Specify Requirements] r Disposaie ld"(Sped ""Requ+rements) ---:- * ------------------------ �- -- - ------------ ------------------------------------------------------------- ----------------------- -------- -------------- (Ckaw existing and required addition on reverse side). I hereby certify that I have prepared this application E and that the work will be done in accordance with San Joaquin Ordinances, State Laws, and his and Regulations of the. San Joaquin Local Health District. Home owner or licen- County y sed agents signature certifies the following: p y arson in such manner "I certify that in the performance of the work lfe h ch this permit is issued, I sha11 not em Io any p as to become subject to Workman's Compensation laws of California. Owner Signed ---------------------- ----------- ----------i------- .- f------------ --- ---- ------- -------------------- E Title -- -- -- ( other n owner] FOR DEI' RTMENT USE ONLY APPLICATION AC EPTED BY - ----- ----------------------------------------------. DATE -- -- r ------ - ---------------- [----- DATE ------------------------------------------- BUILDING -------------------- -------------- ------ BUILDING PERMIT ISSUE -------------------------- --------- ------ ----------------------- ------------------------------------------------- COMMENT --- ---------- -----------------------j------------- ------------------------------------------------ -----------------------_ -- - ------------------------ I-------------------- -- ---------------- :,-. ------------------------------------------- # - -------------------- -- - ----------- 0i ------------------ -- a i -- - ------- ----------- ------------ Final Inspection Y� ---------------- -------- -------�- :�-----� s ,� . � \ ,)SAN.JOAQ L AL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M