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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------"---` -- - �,� � -rte ------- - Permit No. � r _ (Complete in Triplicate) _------_ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and dn�stall the work herein described. This application is made in compliance with County Ordinance-No"�549 and�existing'Rules�and Regulations: JOB ADDRESS/LOCATION . ___. _'7;� --------- - ------- -----=-- --- - ------CENSUS � TRACT -------------- -- ------Phone 6 Owner's Name ------�` T -- --- Address .- --`----- --- --- City ------ ------------------------------------ Contractor's Name ----------------- -- -- - -- - License # ------------------------ Phone c7_10_6_—.A607 Installation will serve: Residence X Apartment House�❑ Commercial []Trailer Court i0 Motel ❑ Other ------------------------------------ ------ f Number of living units:---- "_ Number ofbedrooms -_?'___Garbage Grinder J.'V4?---- Lot Siie z=:__400_ X-- -------- Water Supply: Public System and name -----------------------_-- -----------------------------------------------------------------------------------Privatex- TM , Character of soil to a depth.of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ _ ' . Hardpan ❑ Adobe Fill Material ------------ If yes,type -_____________________ - - 4 _ � (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 seepage p tank or it permitted if public is available within 200 feet,) I � PACKAGE TREATMENT v'[ SEPTIC TANK' ze___-_-_ -- -- _ _ \N ___________ . ________ Liquid Depth ____ ______.____. ' - ----- " Capacity,/_Yf1U__.__,__ Type _ _______ Material_ C�Gr No. Compartments ------------------ Distance to nearest: Well ---_-- Q------- -------------Foundation ----.-/Q:--- _-- Prop. Line -----__---_----_--_-- LEACHING LINE No. of;Lines _-___ �-_-- ----- Length of each line______ 90--------------- Total, Length ------------- 'D' Boxy-------------Type Filter M6terial _ --------Depth Filter Material-.---_ _ --------------------- Distance __ _ _-_Distanceto.nearestWell _.___!�l----------- Foundation- ____f0___;__________, Property line .___+ ______________ SEEPAGE PIT ( ] # Depth --------------------- Diameter' __________ Number ________________ __________ Rock Filled Yes '0 No i❑ -Water'Taljle{Depth --- ---=-------- ..-------------Rock Size 1.---------------------------- i - ----------------- ----i Dist�taance to nearest: Well ----------------------------------------Foundation r------------------. Prop.:Line ------ . - -----=-------- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- i - -------= Date ------------=---------------------) Septic Tank (Specify Requirements) -------------- ------- ------------------------------------- ------------------------,,._--------------------- wewrr'-�� - d Disposal Field (Specify Requirements) --------------0 ------- ----- ------ ----------------------- ----------------------- --------------- - ------- -- -- -- --cC�G� 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." , ►t „ w Signed -------------------�---- -------- - -- ------- - -------------------------------- Owner BY --- -- --- i� s---- f --------------------------- Title ----- - -- ----------------------------------------------- (If other tha o ned i OR .DEPARTMENT U E ONLY APPLICATION ACCEPTED BY __._ DATE __.___ '____ _______ ___ --------•------------------ - ------------ BUILDING PERMIT-ISSUED------ ---------------DATE -------------------------------------- . _.µ -- ..�.--. ADDITIONAL COMMENTS ---------------------------------- ... .-- - --,------------------------------------------- --------------------------- -------------------------------------------------------------''-"-- ----------------------------------------------------------------------------------------------------------- --------------------------------------------------------#�"��A- r-- ` ------------------------------- ---- - - ------ -------------------------'�-,} q Final Inspection by. ------ -- -------- Da#e - 1`�~" l ------ Final SAN JOAQUIN LOCAL HEALTH DISTRICT r e- E. H. 9 1-'68 Rev. 5M