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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No�----.--- r-�� -- (Complete in Triplicate) v Date Issued -....... ---------- ----------------------------- This Permit Expires 1 Year From Date Issued. .; ---------- ---------------------------------------- rict it to and e work herein Application is hereby made to the San Joaquin liancec with Cal o ntvt0 Ordinance a Nom549 and existing Rules tand hRegulations: described. This application is ma P ti ,Y �, - �f/� _ /.#�--- CENSUS TRACT - - ".. JOB ADDRESS/L CAT N ._. = f i� f ;-Pho ne ..--- ---------------- - Owner's'Nam . - f ------------ L� ------ r City Address :- � ,_ License #/I- .r,. f __ - j� Phone ContractorgName _ / - � � `�'T ' " Installation will serve: t :ResidencSZ Apartment House Commercial:❑Trailer Court--,[:] IMotel dooms Garbage a 1 x ❑ � .1{1 Lot Size _,-�-��`-- G e Grinder -- - Number of living units._./_-'--4 Number of be 'I-,' ; _ ------Private _ Water Supply: Public System and name--_---------------------------- Clay Loam ;❑ Character of soil to a depth of,:3;feet.. Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Y I77'ardpan ❑. ,,Adobe Fill Material ----____--- If yes, type (plot plan, showing size of lot location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Size---------- ------- ------------ Liquid Depth = I"1 SEPTIC TANK!j ] + A'-` PACKAGE TREATMENT [ ] ______ No. Compartments " ----- •- ` Capacity --------------------- Type --------- ------ -- Material----- ------ - P , f Distance to nearest: Well ----- - - -------- ----------------Foundation ---------------------- Prop. Line ---------------------- 1 --------- Length of each°line----- ----- --------------- Total Length -----•--------•-------•---- LEACHING UNE [ ] No. of Lines __.__- 'D' Box ------ ---- Type Filter Material --------------------Depth; Filter Material --------------------•-----------•-----•�---- Foundation _____-_ Property Line. --------------- --------- Distance to nearest. We ------------------------ ---------------- SEEPAGE PIT [ 1 Depth -------------------- Diameter ------------- Number ---------------------------• Rock Filled Yes ❑ No ID Water Table Depth ----------------------------------------- ------Rock Size --- --- .------- ----- - ` - Foundation Prop. Line ---------------------- Distance to nearest: Well _______________________________ __ ' ------ ---- Date -------------- REPAIRJADDITION(Prev. Sanitation erm� -------•�----- -- ------- ------------------------- -----------------------•--- Septic Tank (Specify Requirements) ----------- ------- ------- Disposal Field (Specify Requirements), ___-__ �'. �. �----------- _e'1 --- ---------------- - -- .--5 ------------------------------------ --------- -- ---- - ---------------------------------=------------------------ ---------------------------------- ------------------ (Draw existing and required addition on reverse si e me in ce I hereby certify that I have prepared this application that the work will be of the San Joaquin LocaloHeal h Distr'�dCt.nHometh Son owsser or licen- sed Ordinances, State Laws, and Rules a sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shah not employ any person in such manner as to becorne bjeAtkmarnl's mpensation laws of California." Owner Signed .__.. ---------- ------ ----- -- By ------- -----(If other than owner) FOR DEPARTMENT USE ONLY --------------- APPLICATION ACCEPTED BY C - 77-7-7 DATE-�Q- -- -- - ---------- _DAT ------- BUILDING PERMIT ISSUED ------------------ ------------- ------- ---------------------------- ------------------------------------ ADDITIONAL COMMENTS ---------------------------------------------------- ---------------------------------------------------------------------------- - --------------- -------------------- ---------------------------- ------------------------------ --- ------------------------------ ------------------- J �� - -----_-" _________________ --- .Date -- --`--L r-- ------ --------------- ------------------Final Inspection b ------------- ----- -- - ------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. 'T