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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,��3� i y Permit No. _"-_------ -•- --- ----- -------- ---------------------------------------- - [Completa in Tripl'scatel �( F ----------------------------- -- ------ ---- --- -------- -------- Date Issued �G�";�� ` - This Permit Expires 1 Year From Date issued € I struct and f Application is hereby mad rmit to con io the in compliance c l H lth Di triri t for ornce No 549 and existing RvlsstalndhRegulationse work rein described. This application CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION -I. I a Phone ---------------- Owner's Name . Address ------- -- ---- -- - --- ------ City -------------- -------------------_-- - - -- < " - License # �� "._�Phone .--- •----- Contractor's Name .----"- ` `-- a Installation will serve: Residence ,partment House❑ Commercial :r7railei•Court 0 "Motel El Other ---- ------------------------ ------------- Number ------ -----Number of living units:_-.- ----- Number of bedrooms ._":_"--"_Garbage Grinder --- ----.- Lot Size Private 2 Water Supply: Public System-and name -----------=---------- - I ----- -------_- " -" ' Character of soil to a depth of 3 feet: Sand'❑ ilt n Clay ❑ Peat❑ Sandy Loam .Q Clay Loam ❑ f . ------- Hardpan Adobe Q Fill Material ------------ ! Yes,type ---------------------------- location ------- ------ - � (Plot plan, showing size of lot, location of system W relation to wells, buildings, etc. must be placed on reverse side.) C NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) .( Li uid .De th --- C PACKAGE TREATMENT 11 SEPTIC TANK f ] Size------------------------------------- q P I ---------- Capacity ------ Type ------------------- Material-------------------_-- No.,. Compartments --- �� --Foundation - ------- `------- Prop. Line ---------- ------ Distance to nearest: Well ------------- r Length of each line---------------------------- Totol``Lerigth __-.----------- LEACHING LINE [ ] No. of Lines __."_-_-__._".--"__-- -- 9 , i ---_De Depth Filter Material ---------i 'D' Box ------------ Type Filter Material P �; Distance to nearest: Well ------------------------ Foundation ----------------- ------ Property Line. ----- ----------------- Diameter ---------------- Number -".------------------ ----- Rock Filled Yes ❑ No YQ SEEPAGE PIT [ ] Depth -""----------------- '- - Water Table Depth ------------------------------------------------Rock --------- - --------------------------- -------Rock Size -------------------------------- Distance to nearest: Well ---------------------- - -- -------------Foundation --------------- -Prop: Line REPAIR/ADDITION(Prev. Sanitation Permit# ....---------------------------------------- Date ----------- ----------------------) Septic Tank (Specify Requirements) ------------------- - (r - -------------- Disposal Field (Specify Requirements) --- " 3� ---------s----- —-�' -°---j--------- 67 4 ------,�-�`,,`�---`-�- --�`—moo -_-- �-------��--- ---------- ------- ----------------------------------------- _ (Draw existing and required addition on reverse side) 4 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 licen- sed agents signature certifies the following: person in such manner "1 certify that in the performance of the work for which this permit is issued, I shall not employ any as to become subject to Workman's Compensation laws of California." Signed ------ — -------------- --- ------- --------------------------------------- Owner Title --- ------ Y - s--- --- --- --------- (If other than ovine y "� FOR .DEPARTMENT USE ONLY DATE _�- -= " i APPLICATION ACCEPTED BY,1. BUILDING PERMIT ISSUED F -------------------- - ------------------- ----------- DATE -". - - -------- ----- ----------------------------------------------------------------------------------------------------------------------------- ---------- ADDITIONAL COMMENTS i n -"--.--------- ------ ""_-".-_""` - "" __--"- -"""III ------------------------------------------------------" ---- ---- --_----------- ___-"."__ ""-""-r"""-"-_-" ------ ---------------------------------------------------- -- __ ate Final Inspection b -- - - - - - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M