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- -- APPLICATION FOR SANITATION PERMIT ................................................... Permit (Complete in Triplicate) ................................................ Date Issued ..' �._.7..s ' .......................I.................._..._ This Permit Expires t 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: � a�r>�'� � 0(7- ogo-s1 JOB ADDRESS/LOC . .. r .'......... .. ............. Owner's Name ... ........ ......... _..... ......... .'...,...:...._..... .................. .... . .4J ............... Address . ............... ....( �: ............:.... ..-.1.`f•..�_...-! ..... City :....................... Contractor's Name ......i`0� �' ... .�!Z::.....License l��'3........:... Phone .............................. ._...... c� Y Installation will serve: Residence partment House Commercial ❑Troller Court 0 I' - I� Motel El Other ....... .................................. ! / i Number of living units:..1..,... Number of bedrooms •-. ......Garbage Grinder ............ Lot Size .�''- -' '�-- .......•• Water Supply: Public System and name .Private Character of soil to a depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ 1 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,J PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size................................................ Liquid Depth ..._....................:'. Capacity .... ........ Type -------------------- Material...................... No. Compartments ..................... Distance to nearest: Well ....................................Foundation -------------_--•-_ Prop. Line ..................... � LEACHING LINE [ ] 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 [ J Depth ---------=---------- Diameter ____..--"'f... Number ............................. Rock Filled Yes ❑ No C Water Table Depth ........... -••--------------- •----------•--..Rock Size -_-----------------_ Distance to nearest: Well ....Foundation .-. Prop.'Line i REPAIR/ADDITION(Prev. Sanitation Permit# _._...._.................................... Date ... ............................ Septic Tank (Specify Requirements) .------------- ------ -• - .- ....----�-�----•--,•----•----,....--•---......•. ....................... Disposal Field (Specify Requirements) (Draw existing and required-dddition on reverse side) ! j I hereby certify that I have prepared this application and that the work will be done In accordance, with San Joaquin' lth County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Hea .District. Hme owner or licen- sed agents signature certifies the following: ! it "I certiF y that in the performance of the work For which this permit is issued; I shall not-employ any perlon in such manner as to become subject to orkman's Compensation laws of California." Signed ------------ •------ ---• -- ------------ ................. Owner Y1 T...... (if oth r than owner) FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY --------- ------------------'... ---.............................. DATE ..�.'.g.� .. ......... --- •'---- BUILDING PERMIT ISSUED ............... ...... ......................................DATE ............................................ ADDITIONALCOMMENTS ................................................ ---•------•-......--•-'•-----.....--------......---••-•---...._. ' ----------:................................ .....................................•-.................---......... ................................................................................-----------------................... .......... ----------- - ----------------------------------------•-••-•--- rr _ FinalInspection by: .. --•---•..-•----...•...----•----•--.._..................................•----..Date -Z- - G.•-. . . -'-- ---- EH 13 2).t . 1-68 Rev. 5M SAN'JOAQUfN -LOCAL HEALTH DISTRICT 8/74 3M