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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------------ --------------- - (Complete in Triplicate) Permit No: .!o_ w �-��- .r.. 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 wok herein. descricied. This application is made,in compliance with County Ordinance No`-549 and existing Rules and Regulations: JOB ADDRESS/LOCA --- 1 �------ - 14-41--- :I � ---CENSUS TRACT_ ----------------- -------- Owner's Name --- ----- a -Phone�3�.� fyX - Address [ ------- =-- -----------• City —.e,-PI-------- --------------- ----------------- t Contractor's Name ----- s ---- -------------- License # ---------------------- Phone --------------- ---- Installation will serve: Residence Upartment House-[] Commercial ❑Trailer Court ',❑ 4, Motel ❑Other --------------; Number of living units:---- Number of bedrooms _Garbage Grinder --- -------- Lot Size ------ _ Water Supply: Public System and nalme ------------------------------------------------------ ------------------------------------------------------Private Character of soil to a depth of 3 feet:' Sand'[] Silt❑ Gay ❑ Peat ❑ Sandy Loam 2�—Clay Loam ❑ d Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ______ ____________________ (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,) C~ PACKAGE TREATMENT [SEPTIC TANK [ J Siie___ _ __ __ __ _._.✓_�7 .__. Li ___ � � Liquid Depth P _ ------------ Capacity -- :----- CaPacitY _-1,1a-o---. Type Materi _c��No. Compartments -----.Y e Distance �., to; nearest: Well __6_u -__ f__________Foundation ;f d__'-________ Prop. Line _______ _ ______ LEACHING LINE No. of.Lines ......3--------------- Length;_of each_Line=.___�_Q__�'-----------TTotal Length - . � r� / 'D':$ox .__Type Filter Material (_11'P' Depth� Filter Material-'.--.` -.-,r )7_______ _______'.-_....._.. Distance to nearest: Well _ �__�______.__ Foundation .P_`4______________ Property Line ----- -- ....._. � y SEEPAGE PIT [ ] Depth _____ Diameter _______________ Number _ _______________________ Rock Filled Yes ❑ No 0 y I - j Water Table Depth ---------- -------------------------------------Rock Size I it Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- t ' Irv, , REPAIR/ADDITION(Prev. Sanitation Permit# -------------------- -;-----_---:---_--,-_: Date -------------------- SepticTank (Specify Requirements) -------------------------------------------------------------------------------4-------------:---------------------------------------------- I + Disposal Field (Specify Requirements) -----------7------------------------------------------ ---- ` --------------------- --------- ----------------- --------------- - f, ! I E °' ------------------------------------------------ lt ------------------- --- - -------------------- ---------------------------------------------------------------------- ---------------------- ----------------------------------- ----------------------- --- ------ -=----- k {Draw existing and required addition on reverse side) 5 1 i 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: r I "I certify that in the performan'ce of the work for which this permit is-issued, I shall not employ any person in such ma nner4 as to becon1p subject to Workman's Compensation laws of California." I Signed , - ---- _ --------------- ----------------- Owner. BY ---------------- ------------ ----------------------------- -� Title y --- ------------------------------ ------------ 1 r, (If other than owner) R .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ----------------------------------------- ---------------- DATE '_/�'`� ------k------- I BUILDING PERMITENISSUED -------- - --- ---- ---fes ----------------------------------------- - ---- ` ------- --- - --_ DATE - - - - - f ADDITIONAL COMMENTS _________ _.__ --------- -------------------------------------------------------------------- ---------------------------------------------- ---------------------------1----------------------------------------------- - ----------------------------------- --- ----- --------------------------------------- s -------------------------------------------- - Inspection b i --- -- - Date - �- ----- --_--- $ P Y-- ----------- - -- --------------------------- -------------- Final . . .. SAN-JOAQUIN_LOCAL HEALTH. .DISTRICT E. H. 9 1-'68 Rev. 5M. s •; . '. . .