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FOR OFFICE USE: APPLICATION FOR SANITATION PERM T -- - - 'f., � Permit No: --- ------- (Complete in Triplicate) - _------------------------- This Permit Expires 1 Year From�Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and-Regulutions: JOB ADDRESS/LOCAT ON ._ � � --� tr CENSUS(TRA� Owner s Name --- F�i g --------Phone ------------------------------- ---- ------- -= --- ------ -- ---- � ----- - ------- --- Address ---------i-c - _�CY4- --- ---- . City "14-- -- - Contractor's Name 4f_. �' r ;q ----- -----`= ---------'�/-.License # l- _Sly' Phone '- Installation will serve: Residence Apartment House❑ Commercial[Trailer Court ❑ ;. Motel ❑Other ______________------------------------------ Number of living units---------- Number of bedrooms Garbage Grinders------------ Lot Size _ Water Supply: Public System and name --------- ----------- ----------•-------------------------------'= - -Private s Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑j -Sandy Loam Clay Loam,❑ Hardpan ❑ Adobe ❑ Fill Material --- If yes,type _._____________ -_______ - r T (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed ion reverse-side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) (t PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size--------------•----------------------------------- Liquid Depth -----------_--------,----- Capacity -------------------- TYPe�= �e-------- Material--=2--- ----------- No. Compartments : = Q u Distance to nearest- Well __________ ___ - ----------------------Foundation .--- -- -- --- --.Prop. Line ---------------------- �( . LEACHING LINE [ ] No, of Lines ---------------- __ Length of each line---------------------------- Total Length :---__-__✓_____________._ D' 'Box ------------ Type Fil"tee N4ial _________Depth Filter Material --------------- --------------- i i Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line -----------_----------- SEEPAGE ,-._____-_____ SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number -------------------- Rock Filled i Yes ❑/ No .0 Water Table Depth --- ------------------------------------'------Rock Size --------------------------------- Distance ---- -------•-----------------Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---_------------ ---. M REPAIR./ADDITION(Prev, Sanitation Permit# ____________________________________________ Date ____--_-_____________-____________} Septic Tank (Specify Requirements) -------------------------------------:------------- z---------------------------- `, , == bisposal Field (Specify Requirements) -- -------------------------- ----------- --- ---------------------------------------------------- ----------- ---- ------------------------------- - ---- 9 .mac - ------ ------- ---- ------ ------ -� - --- ------- --------------------------------------------------------------------------- f--------------------------------------}--------------------------------------------------------- -�-- --- -------------- t (Draw existing-and-re uired..addition on reverse side) " I 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. Horde owner or licen- sed agents signature certifies the following: I "I certify that i the performance of the work for which this permit is issued, I shall not employ any person in such manner 4 as to beco su ject to Workman's Compensation laws of California." Signed ------- -------------------- -- Owner 0 By ---------------------------- - `` Title - ---- ---- V�-9r . (if other than owner) ' FAR DEPARTMENT USE ONLY I ` APPLICATION ACCEPTED BY - DATE ^.f' •>!a- 1 BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------=--------------DATE -------------• ---------------------------- ADDITIONAL COMMENTS --=---------------------------------------------------------------I--------- -----------------------------------------------------=---------------------------- i 3 -------------_----------------------------------- i - --- ` - -------------------------- -------- Final Inspection by: - "-------------------------------------------------------------------------Date - SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M.