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;i FOR OFFICE USE: i • APPLICATION FOR SANITATION PERMIT c� --------------------- ---------------- --- Permit N.. .1-2---41--- (Complete in Triplicate) ------------------------------------ ---------• __�.............. -------------------------------------#-------:------------- This Permit Expires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health+District fo'r,a permit to construct and install the work herein described. This application is made in compliance with"County Ordinance No. 549 and existing Rules and Regulations: is JOB ADWtt/L6CATIO -� -- CENSUS CT TRA -------------------------- Owner's Name .-- ----- -- - -Phone ---- ------- Address -------- --- 1 l City , ---------------- ------ 's. -- -- Contractor's Name ..- License #I �' ~----_ Phone -- --��0�93__ ...•u.. ' --- Installation will serve: ResidenceApartment House-E] Commercial ❑Trailer Court Motel ❑Other ---------------------------- ----------------- - t 'µ. Number of living units:----_------ Number of bedrooms _- =-._Garba_ge Grinder _-__-:-- Lot Size -------------------------------------------- Water Supply: Public System and name ----------------------- r -------------------------------------..Private Character of soil,to a.depth of 3 feet: Sand'❑ Silto CIa`y,E] Peat❑l Sandy Loam •❑ Clay Loam :❑ A Hardpan ]' Adobe'EJ Fill Material ----______- If yes, type _____________________ f , ------- A y � (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 iif/public-sewer is available within 200 feet,) PACKAGE TREATMENT % f { ] SEPTIC TANK' �] "Size#�--•�_-1---er �._ ______-- Liquid Depth ---- ----------------- Capacity ,9-E.?-b-- fType --- Material_ -- ----- No. Compartments --- ------_-_-_.._- Distance to nearest: Well ---------- 0 _-_--__Foundation ---------- Prop. Line _. ______________ �+ LEACHING LINE { No, of Lines --- ------------- Length of each line-------1_ ------ Total Length --- _ _--__-._-_-_ R 'D' Box --- Type Filter Material __-�3._R------Depth Filter Material -------N �m-�.___---_ Property Line _--__ Distance to nearest: Well --____�©----------- Foundation ___.-- --_ �............. SEEPAGE PIT Depth --- ---------------- Diameter -------3----------,- Number -----------cQ------------ Rock Filled Yes it No Water Table Depth ---------------�7-0-------------•------------Rock Size j .Foundation 1.- ----. �! ' Distance to nearest: Well ------ -f-�----!._....--.,-•- -1� ---------- Pro Line _....-•--.-----•-.---- REPAIR./ADDITION(Prev. Sanitation-Permit# -------------------------------------------- Date --__------_-------___-------_-_-_-) SepticTank (Specify Requirements) -------------- ------------------------------------------------------------------- ---------------------------------------------------------- .,--, I Disposal Field (Specify Requirements) --------- ----- ------------------------------------------------------------------------------------- -- ------------------------------------------------- (Draw existing and required addition on reverse side) 1 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 Work Compensatio laws of California. ----- ,. Signed - ---------------------- ------------ - ----- - ------------ ---. Owner By --------- ----- = =-- Title -- (If other than caner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - -`-- =--- -- ----- -- ------------- DATE ----- lL --------- BUILDING PERMIT ISSUED -------------------------------------------- ---------------------------------DATE ---------------------------------------- ADDITIONAL COMMENTS _---�--__ -------- ------------------------------------------------------------------------ -------••--'------ ---------------------------------- -- --------------------------------------------------- ------------------------------------------------------------- -------------------------------------------------=------------------- ------------------------------------------------------------- / -'•- ------------------------------------ - ----------------------------------------------- -Iq - ---- - - ------- - --- -- Final Inspection by: P �r ------------------------------------------------------------------------Date ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M