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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- ---- - --------------- -------- ---------- Permit No. (Complete in Triplicate) ---------I---------------------------------------------- --------------------------------- --------------- 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 install the work herein described. This application is 'ad in compliant with County Ordinance No. 549 and xisti g Ru es and Regulations: JOB ADDRESS/LOC N '. ''' ---- ------ -------- - ----- --- -- - --- - -CENSUS TRACT Owner's Name Phone Address Contractor's Name _.___ License # / �a__� _i Phone ______________________________ t _ Installation will serve: - Residence [rApartme'nt House-E] Commercial ❑Trailer Court 0 t ti Motel ❑ Other ----------------------- r 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-E] Fill Material ------------ If Yes, type ------------------�--------- ; (Plot plan, showing size of lot, location of systemkin relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic Jan r-seepage p{tRpermitted i,p.lb•fic sewer is available within 200 feet,) JP PACKAGE TREATMENT �,/ SEPTIC TANK �` Size_ __ [ 1 [ 7 y x � x 5 Liquid Depth - -------- Capacity :__r - ,Type .ta. Material-__ No. Compartments =Z-_-_._._______ , I Distance to Weare Well -----------S�------------------Foundation ......./--4-- ----- Prop. Line _.-_ LEACHING LINE [ql No. of Lines ___-- _-- g �line.___.__�oo°-----____-- Total Length : 4-------------- r _ � Length off- each,• �_ so 'D' Box __ Type Filter Material '____.�Depth Filter Material ----H- - ___-.----------------------- Distance _ _Distance to nearest:'.Well -----j91....... -Foundation -------- ----- Property Line _.4�------------------ SEEPAGE PIT (If" Depth _,_ _ -___- Diameter-JJ--- Number ------------ Rock Filled Yes 2r-_*No .❑ Water Table Depth --',-----------?e-----------------------Rock Size ...., - r to Distance to nearest: Well ----------ljop_--______ __________Foundation -------eP-----_- Prop. Line _--_- ..-......... REPAIR/ADDITION(Prev. Sanitation Permit# -------------- ----------------------------- Date .-_-..-__------------__---_-__-_-_) Septic Tank (Specify Requirements) --------------------- - - ------------------- ----------------------------- -------------- ,.. ------------------------ - Disposal --------------------- Disposal Field (Specify Requirements) __---- __-_-_- i ------------------ ----------------------------------------------------------------------------------------------- ------------ ) ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby cerfify 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 liten- 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." r Signed Owner -- -------------------------------------------- a,� Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ---- ------------------- - -------------------- DATE _ "f -__ .�------------- BUILDING'PERMM-ISSUED' .'-- -------- a-- w� ---, ------ "_ _".`. DATE ADDITIONALCOMMENTS ------ ---------- ---- ------------------------------------------------------- -----------------------------------------------------------------•----------- --------- ------------------------------ - -- - --- - ----------------------------------- �s Final Inspection by; :__-. -.__ = ,�. _�_ ---"Date sS= --- SAN JOAQUIN LOCAL, HEALTH DISTRICT E. H. 91 1 68 Rev. 5M