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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --------------------------- ------------------ -------- -0%—ON-�: (Complete in Triplicate) ----------------------------------------- Date issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for 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: JOB ADDRESS/LOCATION �', = C`� -----------------AAlUIi - CENSUS -- - TRACT .P .. Owner's Name ----------- -� Ca u�F---------------------------- -------- - - 91 ---------- - --------- -- -------Phone 93-$ -RTW ------- PA ---- IL - --- City Address " �9 Contractor•shame _.___-__--.-------• � -- --.License # - ----- --""-- J ------- Phone -------------------------•--- Installation will serve: Residence g;,A{artment House❑ Commercial:❑Trailer Court !,❑ Motel ❑Other -------------------------------------------- _ Number of living units:.____I---- Number of bedrooms _ A ----------------- Water "" """ -____Garbage Grinder .___"-_.-__- Lot Size "�- ----- Water Supply: Public System and name ----------------------" ------.-----------------------------------Private Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ -Hardpan ❑ a Adobe--J. .Fill Material --"-= If Yes,type---= - _ - 4' (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,) PACKAGE TREATMENT [ I SEPTIC TANK:[ I Size------------------------------------------------ Liquid Depth ------------------- Capacity - --------- --_ TYP • Ca e -------------------- Material---------------------- No. Compartments ------- �f P Distance to nearest: Well ____.____------------------- Foundation ---- ----------------- Prop. Line LEACHING LINE ( I No. of Lines ------------------------ Length of each line---------------------------- Total Length ----------------------..- 'D' Box -=---------- Type Filter Material --------------------Depth Filter Material ----------------------I------- = _:- Distance to nearest: Well -------------"--------- Foundation ------------------------ Property Line --------•---•----------- __ SEEPAGE PIT [ ] Depth ---------------- --- Diameter ---------------- Number ---------------------- ---- Rock Filled Yes '[] No C3 Water Table Depth ---------------- ------ -----------•Rock Size ------------------------•------- Distance to nearest- Well ----------------------------------------Foundation -------------------- Prop. Line - ----_.------ REPAIR/ADDITION(Prev. Sanitation Permit# """_---------- ------------------------ Date ____-_____.-------..------•--- ---1 Septic Tank (Specify Requirements) --------- C ------� �----X '_ --------------------------------------------------- Disposal -----------------•,_-------------- • --------- -------------------- -------xrsr�PG ` Disposal Field (Specify Requirements) ------------- - - --"""--"""""-" ------- t_ ._.____ .-- - -----_------_�--------= - ----: � - --- (Draw existing and required addition on reverse 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. Home owner or licen- sed agents signature certifies the following: "I certify that ' N mance of the work for which this permit is issued, I shall not employ any person in such manner r as to b com Ie to 1iNorkman's mpensation laws of California." F Signe -------------------- Owner -- -------- -------- Title ----------------------------------------------- -------------------- (If other than owner) FOR DEPARTMENT LIS ONLY APPLICATION ACCEPTED BY -------------------------- DATE --- ---- - --------------------------- ----- BUILDING PERMIT ISSUED ------------------------ -------DATE ADDITIONAL COMMENTS ----------------------------- ---------------------------------------- ------------------------------------------------------------------------------------------ ---------------------_-_-j-- ----------- 4:! -- -- - ------------------ - - r-- -- 1Date Final Inspection b SAN L AL H E. H. 9 1-'68 Rev. 5M