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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No _ /Fd . .....--- 5 ----------- (Complete_ in Triplicate) ---- -- --------------------------------------- �.� -1�--�--. ------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for ❑ 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: JOB ADDRESS/L CATIO, ? ------ --CENSUS TRACT Vf . - l© 7c - L - Phone------ Owner's Name/ 4'l - ----- r ---- ,Address a City --1 -------------------------------- Contractor's Name (,� -------------=-------License Phone i' Installation will serve: Residence partment House❑ Commercial :[-]Trailer Court l❑ Motel ❑ Other ---- -------------------- ------------------ Number of living units:------/.... Number of bedrooms .--&---Garbage Grinder tVO---- Lot Size -----4�4 re-4----------- Water Supply: Public System and name ------------------------------------------------------- ------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay-Loam ❑ Hardpan ❑ AdobeAf Fill Material ------------ If yes, type ------------------------- -- (Plot plan, showing size of lot, location of systemInrelation to wells, buildings, etc. must be placed on reverse side.) r NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth ------------------------- Capacity - ---- ------------- Type -------------- Material Na. Compartments Distance to nearest: Well ----------------j-=----------------Foundation ---------------------- Prop. Line ---------- _-------- LEACHING LINE [ } No. of Lines ----_..__..---___. -- Length of each line---------------------------- Total Length ,.._---_-----_--------_-- 'D� Box ------------- Type Filter,'Material --------------------Depth Filter Material -------------------- ------------------------ i .......... .` --------- Foundation --- -------------------- Property Line ----------- k Diameter SEEPAGE PIT [ ) Depth cep o nearest- Well -- er . ---------------- Number -----.-----------.---------- Rock Filled Yes ❑ No .0 \e Water Ta61eN-P®pth ------------r., r--------------------------------Rock Size ----------------- -------------- Distance to nearest: Well _-- -----------------------------------Founclation ---------------.---- Prop. Line _'c..-...__.-_._.-___- REPAIR/ADDITION(Prev. Sanitation Permit# -= -------- ------ --- ---------------- Date Septic Tank (Specify Requi ) rements . . ' t — / ----------L ----------------- --------------- Disposal Field (Specify Requirements) ---------------. �. :_ ---- - - ------------------- --------------------------------- ------------------------------=-- -------------- -------------------- - ---------------- --- ------ -------------- ---------------------------------------------•------ - = --- --------------------------------------------------- -------------------------------- - -• _[Draw existin_-gacl requi-redsgddjtion on reverse-side) I hereby certify that I have prepared this application and that the work will be done ih-accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health'Dist;icf. Home owner or licen- sed agents signature certifies the following: I i11 "I certify that in the performance of the work For which4his-permit islissued, I shall not employ any prion in such manner as to become subject to Workman's Compensation laws of California.'." Signed Owner BY ------- Title ---- -- - ----------- ---------- ------------ -- -------- ---- - ----------------- (If other th owner) DEPARTMENT USE ONLY k APPLICATION ACCEPTED BY . ---- -----_- " Y DATE f � �= fes BUILDINGPERMIT ISSUED --- ----- - -----------------------------------------------------------------_;-DATE _ .,, : = ----------------------------- ---------------------------- ADDITIONAL COMMENTS ---�-------- ------- ----- - ------;---- -------- ---; ---------------------------------------------------- --------------- -------------------------- = -------:------��1�: --- ------33 �s -- ---e---------------------------- .4 - = I --------------------- --- - / -- --- -- --- ---------------------------- - ----------------------- Final Inspection b ---- ----------------------------- -- ----------------- Date P Y �• JOAQUIN LOCAL 11 HEALTH ZISTRICT E E. H. 9 1-'68 Rev. 5M f