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FOR OFFICE USE: rAPPLICATION FOR SANITATION PERMIT ---------=------ F a W _ (Complete in Triplicate) . Permit No. -------------- ---------------- _ Date Issued -6-� ------- --------- ---- 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. I i I �� ^ JOB ADDRESS/LOCA71 N __ " !� _ (./ Owner's Name v' � --------- -- ------- --CENSUS TRACT l ------------- - 1 -- ------.---- ---------- -------- - - ------ --Phone -- --------------- -- Address / ------------. Cityes-� F- Contractor's Name/� --------- uv � „" �� License Phone Installation will serve: Residence Rlf(�partment House❑ Commercial : Trailer Court 0 �- /7'� /c Z_ Motel ❑Other ______________ _ Number of living units:--_2- --- Number o ed oo s I �.__Garba a Grinder��_--- Lot.Size rr '� x Water Supply: Public System and name," _""-_ __J_!_ _ -r �e, ` I ---- � ------------------------------------------------------Private ❑Character of soil to a depth of 3 feet: Sand'E] Silt.[] Clay ❑ Peat❑ Sandy Loam •❑ Clay Loom•. t Hardpan ❑ Adobe i I Material ------ If If yes,type ------------------------------ (Plot ------------ -----__ --(Plat plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.j NEW INSTALLATION: (No septic tank or seepage pit:permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT FW SEPTIC TANK f ] Size- - - Liquid Depth " �Z \ '.Capacity f�G v _ Type �Y��. Material"�lz_�_r'�No. Compartments 2--- Distance to nearest: Well .... �/o�✓ _---""--__"Foundation .--� _y ----------- Prop. Line _", ---•----- LEACHING LINE [�1f `No. of Lines ___""-_ Length of each line___ . _ - -�-,-'`t------------ Total Length _ _ D' Box _/ p_ -Type Filter Material � _DepZ- ilter Material -,�' �S "" Z_' 5 "" ------------------------------- Distance to nearest: Well ._ -ter--" -____ __ Foundation ` ' sr Z Property Line "- - ---------------- [�, SEEPAGE PIT [ Depth __ t _-----_ Diameter - ---- Number ------- -------- ( ---------- Rock Filled Yes No Water Table Depth ":__.�Q _-_Rock Size X. ------------------------------ or Distance to nearest; Well ___________________Foundation ---- ------ - Prop. Line ... ..... REPAIR/ADDITION(Prev. SaniGion�Permit# ----------- ----------....................... Date ) Septic Tank (Specify Requirements) --------------------- Disposal Field (Specify Requirements) --------------------------------- - ------------------------------ ---------------------------------- - --------------------------------------------------------------- (Draw existing and required addition on reverse side) ' I hereby certify that i have prepared,this application and that the work will be done in accordance with Son .Joaquin ;. 'l 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 Workman's Com ensation laws of California." Signed -------------- Owner ---- -------------------------- By -- -------- -------- --- . ; o ------------- Title -------- ---- ------- ----------------- (If o r than owner) ------------------ I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --"__- �,_ ��_ BUILDING PERMIT ISSUED :_-- -- _-- 1 __-- -- ----. DATE - -"�Jq--------------- ------------------------------------------------- ADDITIONAL COMMENTS".5=, (1 TE __------ " DA r ------ ------ ----------------------------------------------- -- -- -------- -- ----------------------------------------------------------------------------------------- --------- --------- ----------------------------------- ' ----- ---------- Final Inspection by: ------------- ----------------------------------------------- ---------------- --Z- —�-� Date ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.