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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 5� t Permit No,?f`------------ ------- ------------------------------------------------ (Complete in Triplicate Date Issued ------------------------ -------- ------ _ _ This Permit Expires 1 Year From Date Issue � Application ;s hereby made to the San Joaquin Local Health District for a per to construct and install the work herein PP described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. i .�_ --------CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION ZI t Phdne------------------- -----------••-- Owner's Name - ------------------------------------------------ -------------------------------------- e------ -------------- 7 �- ,✓� -. City Address --- -- �-� -- --�-� ' License #/,f/ Phone - s Contractor's Name ..-- 7- Q -; Installation will serve: ; Residences Apartment House�❑.Commercial ❑Trailer Court ; - f eMotel ❑ Other -------------------------------------------- , Number of living units------- Number of bedrooms _____..Garbage Grinder ____. Lot Size ___�4 't-4`` � = ' ------------ -Private E Supply: Public System,and name. -----------------S- -------- ------------------------------------------------- Water - Character of soil to a depth of 3 feet: 'Sand❑ ilt❑ Clay ❑ Peat ❑ 5andy Loam [+ Clay"Loam Hardpan ❑ Adobe ❑ Fill Material ..........I if Yes,type -------- - ----- placed on reverse side.) (Plot plan, showing size of-lot, location of system in relation to wells, buildings, etc. must be oq NEW INSTALLATION: (No'septic tank or seepage pit permitted if public sewer is available within 200 feet,) 14 PACKAGE TREATMENT { ] I SEPTIC TANK'{ ] ----•�_. ._-Size-~-=---- -----=- ----------------------- Liquid Depth -------------------------- - k Capacity -------------- Type - Material---------------------- No. Compartments -.--------- Distance to nearest: Well _______________<-- -- Foundation Prop. Line •.. - Length of each line--------- - ---- Total Length ------- 'D' ---- _ LEACHING LINE [ ] No. of Lines ------------------------ g F: ----------- Type F+Iter Material Depth Filter Materia ------------------------------ ------------ _.. -- - 'D' Box ---- - - - � .� _ ,:,• �.. � Property Line ------------------•--•-- pistance to nearest: Well --------------------- -- Foundation. _.._------------ p � Diameter -- Number .-__---------------------- Rock Filled Yes 0 No C I SEEPAGE PI [ ] Depth ----------- k _____Rock Size -------------- ,,. Water Table Depth ---- --- ------- -------- --------------- - - Distance to nearest: Well ----------------------------------------- Foundation -------------------- Prop. Line-------------------------- -------------- ....... ------------------ Date ----------------------------------) REPAIR/ADDITION(Prev. Sanitation Permit k - ' I Septic Tank (Specify Requirements) ------------------------------------- Disposal Field {Specify Requirements) ------ -------------- -----------------�------ ------- M _ ----f! �V - - -- •- --- ---------------------------------- ea ---- - ----------------------- ----------------------------------------------- --------- -- a -- -_-�- �- - ' . Jf -------------------------------------------------------------------------------------------------------------- F (Draw existing and required addition on reverse side) I hereby certify that 1 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: for which this permit is issued, l shall not employ any person in such manner "1 certify that in the performance of the work as to become subject to Workman's Compensation laws of California." IOwner Signed Title ..-- ---- --- i {if other than owner) FOR .DEPAATMENT USE ONLY f "- DATE--t:7--/ 1 -- APPLICATION ACCEPTED BY __. :_ ---------------------- ---------- -------- -- DATE = iBUILDING PERMIT ISSUED ------- ------ ------- ------- -------- - --•--- ------ ---------------=- --------•----- -----•--• ADDITIONAL COMMENTS ------------------------------------------ ------ ` - - �--------- ------------------------------------------- i ----------- f --- -- -t-7_'y i -- --- ---- ------ --- --- - - 61 - -- -- ----------- ------------------ ---------------------------- -- --- -- Final Inspection by: -- - f---------- -------------------- Date _: SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M '_.