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! FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT L �, Permit No -----` (Complete in Triplicate) . : p Dote Issued -------- --------- ----------------------------- This-- Permit Expires 1 Year From bate issue t for a rit to construct and in Application is hereby made to themade com liancec with CounttyealthtricOrd Ordinance Nom549 and existing Rulestalnd Regulat onsreir. described. This application is ma p JOB ADDRESS/LOCATION --��--�•-------- - ----- - " -- -- - ------CENSUS TRACT - fi one ------- Owner's Name -------- -- -- --`-- ------------ ------ !- ---- ------------ # _L------------ Address - - ---- --- •-�CitY it License # [----- Contractor's Name ---- --- ------------- --- - ---�---- --- -------- ` Installation will serve: ResidenceApartment House°❑ Commercial []Trailer Court i❑ Motel ❑ Other -------------------------------------------- 75--- Lot Size - X Number of living units:____ ---- Number of bedrooms :-��_Garbage Grinder f ' � Private ❑ - ---- -- --- - k Water Supply: Public System and name ------------------------- __ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy�Loam ❑ Clay Loam ❑ Hardpan ❑ E Adobe Fill Material ------------ If yes,type ______________________ (plot plan, showing size�of' lot, location of system in relation to wel.ls,-_bu.ilding's;�:etc. muslaced on reverse side.) t.be p to NEW INSTALLATION: (No'septic tank or seepage pit permitted if public sewer is available within 200 feefi,)C-Z/�r I Size Liquid Depth _ .__T F PACKAGE TREATMENT . ( ]�,SEPTIC TANK _-- Material__ ? No. Compartments --- --------------•--- O Capacityf W --- Type /f- l-'---�� P• -�- ---------- -----------------Foundation ----" --------_-..- Pro Line _--- I � • ~ .. . 4 LEACHING LINE No. of Lines nce to nearest: We Length of each lin e____l�y------------ Total Length 1_�----•---------•-- � S fr 1 ' 'D' Box -----_____-. Type Filter Material ---Depth Filter�Material -.�_ --------- r -_L_ Property Line ---- -- •----- T--Distance to nearest: Well -----�__________ Foundafiion• �---: SEEPAGE PIT Depth --- ------ Diameter __16------ Number ---------1 .----------- Rock Filled Yes No ❑ ` 11—1 'Wafer Table Depth -_- --- -Rock Size ��--- /�----------------------------------- e Distance to nearest: Well ,�_:-----------------------------•--Foundation - ----------- Prop. Line ---------•---- ` ------------------------------- ) REPAIR/ADDITION(Prev. Sanitation Permit# -------- --`_------- Date Septic Tank (Specify Requirements) ----:N---------"--------------------- - s Disposal Field (Specify Requirements) -------------------------------- ------------------ -------------------------- f , _________________ iS ------------------ - ----- -- g ------------------- and hereb certi that 1 have prepared Draw is application'cation required addition k reverse side) I y fy. P p Pp anti-'Fh ut-tlse'work'will kie done in accordance with San Joaquin County-Ordinance"s, State Laws,".4—Kd.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 su .joct to Workman's Compensation laws of California." Signed { . �. Own er �� (t -------- --- ------------ ---------- - - --------- ----------------------- B -- - to Ti - f othe th n.owner} FOR DEP A T USE ONLY - "- - - - _ DATE _-.._- .1-)-,- _v----------------- E ---------------- APPLICATION AC EPT D BY - DATE ------------------------------------------- BUILDING --------- -•------ ------------------- -- BUILDING PERMIT ISSUED --- -- --------------------- ---------------------------------------_ ------------- - - -- ADDITIONAL COMMENTS . _ ----------- - - -- _ __ _ ______ - ______:�_fz: _ ______ -__________ __________ __________ _ ________ __________-_::____::-::::._: ------- ---------------------------------- - ----------- ---------- ---------- -------- -- __.Date _ ---------- Final Inspection by JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ___