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FOR OFFICE USE.. APPLICATION FOR SANITATION PERMIT Permit No.1�_�-•�-�!• ----------• --- ..................... a (Complete in Triplicate) -.............................................................. Date Issued __�:.�.�.-�-71 This Permit Expires l 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 Regulations- described.This application is made in compliance with County Ordinance No. 549 R d existing Rules and Regulations: p CENSUS TRACT .......................... JOB ADDRESS/LOCATIO -�• 1,..-- ____._...._... C�.------"-- Phone --------------------•-----••------•- Owner's Name .--_- -- - -• •-•-•- •/-�-••/ - Address ---•------- ._�_� C.• ._... - .. City .. ' -- -•--•-_.License# .........,....----- Phone ---_- •---_---.-. Contractor's Name•.,.._ -•---• --------�-•- --•• -----""--•• Installation will serve: Residence Apartment House❑.0 mm rciat❑Trailer Court ❑ C]Motel F1 Other ---'-f� • .?y.. .. Number of living units:......--- Number of bedrooms --Garbage Grinder Lot Size ------ •----..... --- ••--•-------••- •----------•-----Private�f Water Supply: Public System and name ----............................................................................. ............ Character of soil to a depth of 3 feet: Sand Silt❑ Clay X I Peat E] Sandy Loam ❑ Clay Loam C]Hardpan E] Adobe ❑ Fill Material ............ if yes,type--••-•----•------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) l� r r S r 1 X Liquid Depth ._.. -•------_---•---- PACKAGE TREATMENT [ ] SEPTIC TANK� Si�e_ .a---/ -- ••--- - Capacity 1 -Q-..._. __. Typea . Material._ -Q's---- ---- No. Compartments .__..ate.-------••-• �..e---•-- Prop. Line -_S•-- .._..... Distance to near t: Well _..____.�.- ................Foundation .--4 4 c_.�----. Total Length .............. LEACHING LEACHING LINE [ KNo. of Lines ..........1------------ Length of each line..._.-.__l..__-- 'D' Box ...•r—____ Type Filter Material --- .----Depth Filter Material ...... g---••-•-•-•- ........ ......... __/-o............. SEEPAGE PIT Depth _._.._C -r- Qiameter .✓�.�r•---- `lumber _._.....c --------------- Rock Rock Filled Yes [ No C3 Water Table Depth ............. Q-r----- Rock Size .1��.! . Distance to nearest: Well ........_.��€?.©--r•••---•--• •--•_Foundation .I.. ____...----••- Prop. Line ..............• ...�. REPAIR/ADDITION(Prev. Sanitation Permit# __.._._.. ............... - - -------•------- Date •---•- •----•------•--------------} Septic Tank (Specify Requirements) ---•---- --------•- ................ .................. ------- --------_------- - Qisposal Field (Specify Requirements) ............................. ............................... ------------- -- -----• •"---•---------••----------------•- --•---------.._....._...........----._....._...... ................................................................... ...............................-...................................... .................... (Draw existing and required addition on reverse side) I hereby certify that 1 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 lic*n- sed agents signature certifies the following: ' employ any person in such manner "I certify that In the performance of the work for which this permit is issued, I shall not emp y as to become subject to Workman's Compensation laws of California." - __-owner Signed ------...-- •---•------- - -------- --•=- ---••------- - - - - -- - Title ..._ --------- - -- - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. ----- •--•-••- ......................... DATE ---------------- . DATE -------•---•-------------- ----•--•-•--•--- BUILDING PERMIT ISSUED ------------------------------------........................................... .......................... ADDITIONALCOMMENTS .-•-----•".................................•-•-...------------•---•--------• ----------- ----- --------... ......Date .. �.. Z•'. . Final Inspection by: . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M