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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- -- ----------------- ------------------ __7-�~l-�� (Complete in Triplicate) Permit No. - --------------------------------------------------------- // ______________________ This Permit Expires ] Year From Date Issued Date Issued __c/7_5-`,_73 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: JOB ADDRESS/LOCATION .-_`D-Y�_-_--'�__------ -- 0 _ ._ f`-�-t------------------- CENSUS TRACT -------------..--.-------- Owner's Name -------- - -------- ---------- Phone -o5�_' _7!� 7----- Address -------- ------------- �' City --------------------- Contractor's Name ---- - - - _-- _-- -------- ---------------------._---_____.License # -- - -------- Phon 7 Installation will serve: Residence Apartment Nouse❑ Commercial :❑Trailer Court i❑ Motel ❑ Other ------------------------------------•------- Number of living units----- 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❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Moterial ------------ If yes, type ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 1 NEW INSTALLATION: (No septic tank or seepage pit perm i pu is sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK[ I Size ___________ ______________•____-.__-____---- Liquid Depth ___-______________-_____- N` CapacityJe ----- Ty P --- -- -- ------ M ial--------------- ------ No. Compartments ------ ............... Distance est. We _______ ______ -------------Foundation --------- ------------ Prop. Line __-_____________ LEACHING LINE [ j No. of Li ______ _____ ____ eng of each line._____.________---_------- Total Length -----------------.__________ 'D' Box - YP Fil r ateri I --------------------Depth Filter Material --------------------.-----------------.---•- Distance st: ell ________________ Foundation ------------------------ Property Line _______---.____-._...___ SEEPAGE PIT [ ] Depth ___ ______.____ Rock Filled Yes ❑ No i❑ ! --- .Diameter ---._..�-------- Number -- ------------ . WaterTa --------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------- ------Foundation -------------------- Prop. Line -.-------------------- REPAIR/ADDITION(Prev. Sanitation Permit# --------_-----------------------------------___ Date ________-____________-__________) Septic Tank (Specify Requirements) -------------------------------------------- -- -- --- -- Disposal Field (Specify Requirements) --- L -- ---- ------- ti-= ----------------------------------- ------------------------------------------- >---------------------------------------------------------------------------------- (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 Mules 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------------------------- Owner BY ---- -------- --- - -------- ---- Title ----- --------- -- - - (If other owner) EPARTMENT USE ONLY.,, APPLICATION ACCEPTED BY ---- DATE �7 ��— e BUILDING PERMIT ISSUED - -----------------------:------------------:--------------DATE ------------------- ------------------------ ADDITIONAL COMMENTS ----------- ---- ----- ---- - ----- --- ------•---------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ FinalInspection by: ---------------------------------------------------------------------------------------------------------------------Date .----------------------- ----------------- J SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M