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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � Permit No,. --- ---------------- -- --------------- --- {Complete in Triplicate} Date Issued ----------------------- ----------------- -------- - This Permit Expires p 1 Year From Date I ssue -. Application is hereby made to the San Joaquin Local Health district for a permit to construct and install the work herein PP application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: described. This app ' i - - - CENSUS TRACT -------------------------- G r/.a JOB ADDRESS/LOC TION .- ------------ --� - 'i--- - i /} - ----- R ----------------- -------- Owner's Name.!y ��G Address __ � - City --- - ----------- s,3 ---- ---- -= •-------- _-/ 1/ ' -------------- ---------License # `�/ a- Phone ` =d---------- ---------- Contractor �-�7s� Contractor s Name Installation will server Residence ❑Apartment House°❑ Commercial :❑Trailer Court € f t a Motel ❑ Other ------------------------------------------- - .� � --------- Number'of living units/. 00- Number of bedrooms .-----------Garbage Grinder __--_____- Lot Size _-.---- ----- Jll. - Private Water Supply: Public System and name -----------------------------------•------------------ -- -- Cla Loom :1] t Character of soil to a depth of 3 feet: Sand'❑ Silt�] Clay ❑ Peat❑ Sandy Loam`❑• Y ye---------------------------- Hardpan { ' 1] Adobe Fill Material if es,type WI r buildings, etc. must be placed on reverse side.) ! ! i (Plot plan, showing, size of lot, location of system in relation to wells, 1t t NEW'INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) t^1� _ Liquid Depth -------------------------- PACKAGE TREATMENT 11 SEPTIC TANK'j I Size-------------------------------------Type No. Compartments ------------------ Capacity ----- ---. --- acct s P i _-.Foundation ------------------ Prop. Line -------------•-- Distance to nearest: Well .___-------- - �11 14' Total Length LEACHING LINE t ] No. of Lines ---------------- Length of each line ------------------- - ------------ ------------ 'D' Box ----------- Type Filter Material --__-----------= -Depth Filter Materia ` r Property Line --- Foundation ----------------- P rtY ------- ----- - --- ---- `� Distance to nearest: Well _---_--------------- , , 01 Diameter -----------------Number -..------------------------- Rock filled Yes ❑ No 1❑ 37 SEEPAGE PIT [ ] Depth Water Table Depth ------------------------------------------------Rock --------------------------------------=--------Rock Size -------------------------------- I -------------------- s F "a Distance to nearest: We ------- --------- Foundation ---------------•---- Prop. Line --- -----•------ , Date ------ -------- ~ . f REPAIR/ADDITION(Prev. Sanitation Permit# ----- --- -- — ------ " Septic Tank (Specify Requirements) --- - ----------------- - Disposal Fiel {Specify Requirements) ------------------ I ` ----------------------- -- (- '(0raw existing an required addition on 'eve se side) : x- �thatil have prepared this application and that the work will be done in accordance with San 1 hereby certifyJoaquin County Ordinances, State.laws,.,and,Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents`sigriature'certifies the following: "I certify that`in the perForrnance of the work for which this permit is issued, I shall not employ any person in such manner as to bet sub' at to%W rnan' mpensat' s of California." Signed - caner t w# F �' ( ----------------------------------- ------------------ f ----- --- ---�`��-- Title - ----- -- "------ -- (if.other than owner) <t } t, R DEPARJMENT E ONLY ` DATE 1- +---------------------- DATE --- APPLICATION ACCEPTED, BY-_ -_ ---- - �- -- ------------------------------- - BUILDING 'PERMIT ISSUED--------- '---------- ; ADDITIONAL'COMMENTS -----------:. ,-------isz ------- = ------ - i ==_ ------ F 1 � } - ----------------------- --------- ------ ----------------------------------- _. --------------------- -- -'-------- -------------------- - . r ate--.. Final Inspection by: - -- -- - t - SAN.�JOAQUIN ,LOCAL-HEALTH-DISTRICT, _,.., E. H. 9 t 1-'68 Rev. 5M