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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------- - - -------------•-------- ------ Permit No. (Complete in Triplicate) ------------ ------------------------------ -------------- - Date Issued This Permit Expires 1 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- ------------------- -- egulations: JOB ADDRESS/LOCATION ._/ ��%-- --------------- - CENSUS TRACT ~� -------Phone ----------------------•--- •---- Owner's Na e_r� �=��`?`'----- -------- -•-- --------- ------------------------=------- --------_---- --• • y Address '. ------------ City --- -----"F � �----_-- f; -- ---------- -- Contractor's Name ''' -- --- -- ------ i--- --------- -e-- --------License # --- Phone --- -------------------------- Installation will serve Rsiden e0Apartment House❑ Commercial:❑Trailer Court ;❑ iMotel ❑Other -------------------------------------------- i Number of living units:__:__r____ Number of bedrooms --------Garbage Grinder ------------- lot Size ----------- -------- _________....____ Water Supply: Public System and name ---------------------- --------------------------------------------------- ------Private [� Character of soil to a depth of 3 feet: Sand![:] Silt El Clay E:] Peat EJ Sandy Loam -F-1 Clay Loam;[ Hardpan ❑ Adobe F-1 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 Itank or seepage pit permitted if public sewer is available within 200 feet,) r PACKAGE TREATMENT { ] SEPTIC TANK'[ Size_�-,f L�_____X..__5--_----__._____ Liquid Depth __ _________________,_---- Capacity iJPDP___ Type lea I --- Material_ �-------- No. Compartments ___ .._...-_--_. r O r Distance to nearest: Well --------- 7e,____-----------------Foundation ----gip___-___-___- Prop. Line ______._S_.:_.___-. LEACHING LINE [ No. of Lines _____-3____________ Length of each line________' -_!_.-______ Total Length ____[- _..�.:_.___. .t I r .. 'D' Box . D�tO Type Filter Material _____-� ----Depth Filter Material ----------f_�_______-___________________ J.. - Distance to nearest. Well --------�0_r------- Foundation ------ --------- Property Line ______. `______________ SEEPAGE PIT [ KDepth ___--.__ ____ Diameter ___- _: _-Number--____ - -_--_<______ Rock Filled Yes !Eb.w No i❑ t - rr #r f, _DistWater Table Depth --------------�--- --Rock Size � -------- Distance ance to nearest: Well -----------I_ ---------------------Foundation ----I-F_r______ Prop. Line �I REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------------- ) ' I Septic Tank (Specify Requirements) ---------- ---------------------------------------------------------------------------------------------- __-- •-------- Disposal Field (Specify Requir'ements) ------------ - ----------------------------- ----------------------------------------------------------------- I I - - ------------ f , ----------------------------------------------- --------------------------------------- ---------------- ---------------------- ----------------' --------------------- ------------------------------------ -------------------------------------------------------------------------------- ------------------------------------------------------------- .I (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 in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------ ---------------- -------------------------- f ----- Owner ,7 Gz. ------------------------ ---------- ------------ --------------------------------------------------------- Title _ ~� (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED E ------------ ---------------------------------- --------------------- DATE _11-49--. BUILDINGPERMIT ISSUED ---------- -------------------------------------------------------------------------------- --------------DATE - --- --------------------------- --------- ADDITIONAL COMMENTS iA ------- ---- ---------------------------------------------------=-------•-- ----.. ,i _ -- -------- ------------------------------------- ------------------------------------------_------ ----- -i---------- Final Inspectlor4-lap: -- ---------------------------Date -�l=�� ----- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT t -'68 Rev. 5M I . H. 9 1