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FOR OFFICE USE: ` � _/, I APPLICATION FOR SANITATION PERMIT �� 7 --------- --------- 1� `' " �o -- Permit No- -------------�%�-- " .1 (Complete in Triplicate) --------- ---- +»� Date Issued _-----------------___----------------------------- ' .. This Permit Expires 1 Year From Date Issued E 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 . 549 ' d existing Rules and Regulations: JOB ADDRESS/LOCA N .--- -- - -- - -----t .J-- ---f- - .- [ _..- -___.--CENSUS TRACT -------------------------- t Owner's Name t . l Phon Address A '� r '� i � _ City �i ` J� - - _-------------Contractor's Name' ----- � ,_.License #IrAs"�l -- PhoneInstallation will will serve: ResidenceApartment House❑ Commercial ❑Trainer Court '❑ Motel ❑ Other ---- -------------------------1------------- Number of living.units:_o,�._ Number of bedr ams G bage Grinder -,AIV--_ Lot Size rOQ_)r,_l. o_________________ Water Supply: Public System and name _____ 6 __-__ _p (/�G�s__ ________________-_._______Private El E Character of soil to a depth of 3 feet: I Sand' ❑ y ❑ I ❑ !y I ❑ y M ❑ iit Clay Peat Sand Loam Clay-Loam .M Hardpan ❑ Adobe X 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: fNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) ;r } IC TANK' ! -- PACKAGE TREATMENT [ } SEPT s / Size_____,�__��.�_ _________ _ _______ _ _ Liquid Depth _�Z---------------- Capacity �� _s_ Type(�'J_t� Material- No. Compartments __�------------- U 1 i ti. v Distance to nearest: Well __.N_j0_A)6i7_______ _--__Foundation 1�------------ Prop. Line . "________________ LEACHING LINE [ ] No. of Li�es � r e r _--_--_ '� _j� _----. -- Length o each me __��`:f------ -�--- Total Length -�.Q---.----- 1 i ` .'D' Box _ ---------IType� Filter Material _ Depth Filter�M€aterial _-Zs ---------------------------------. 'k Distance o nearest: Well-,!IVlr� -/__--Foundation ---._-1------ Property Line _____-__________ SEEPAGE PIT Depth W- - Diameter Number ". I_- Rock Filled Yes No .❑ ` /� rt Water Table Depth ------7--s`'-_° -------k-----------------Rock Size•----7- -----Z-----rr- ------- Distance to nearest: Well .../`-'-p-lve-_______-----------Foundat•ion . ------ ____ Prop. Line REPAIR/ADDITION{Prey. Sanitation Permit# ------ ------------------------------------- Date __________________ _______________} , ;� SepticTank (Specify Requireme,ts) -----------------------------------------------L-------------------------------- ---------------------- , --- ----------------------- Disposal Field (Specify Requirements) ____________I_ if ------------ --------------------------------------------------------{-------------------------------------------------------------------------------------------------------------------------- 1_-- ------------------------------------------------------------------==----------------- ---------------------------------------------- {Draw existing and required addition on reverse side) 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: "I certify that i e performance of the work for which this permit is issued, I shall not employ any person in such manner as to become u ect to Wor an's Compensat0j, laws of California." Signed -- ----- Owner By ------ ----- Title --------------------------- '� �- If other than{--owner)'- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ' r` "�r------------------- ------------------------- -----. DATE _: � BUILDING PERMIT ISSUED -[----------------------------------------------------------------------- ---- DATE ---------- -- ----------------- ADDITIONAL COMMENTS ._.___-.___-I - - ------------ - ---------------------------------------------------------=--------------------------- ----- 1 c� ----------------------------------------------- - ----------------------------- - --- - --- ------ ,Final I,ns ection b _ . - - _ _ _Date --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.