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r FOR OFFICE USE: A,PI'JILICATION FOR SANITATION PERMIT --------------------------=------ -- ---- '' ` Permit No: +-------- (Complete in Triplicate) ---------=----------------------------------------------- P 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 com liance with County Ordinance No. 549 and existing Rules and Regulations: t JOB ADDRESS/LOCA 1V � ---------------------=-----------------CENSUS TRACT -------------- - ; Owner's Name ------ -- 'Q=�"1"S. '�- Phone . - -- - ---- - / fJ { Cit �? ---------------------------- ---------- Address -----(�-�--- - -----r--�-- -- ------- --- --------^" �---�__ Y -:---f G Contractor's Name ------ - - -- =----1- --- --- ---------- - - - ---- - -- - ------- License # _/ J� �hone ------------------- ---------- Installation will serve: Residence 'Apartment House Commercial ❑Trailer Court ❑ Motel ❑Otherti------------//------------I----------------- Number of living units:____------ Number of bedrooms ____YGarbage Grinder ----______,_ Lot Size ______-- Water Supply: Public System and name ----------------------•`------•---------------------------------------------•----------------------------------P Ovate ®� Character of soil to a depth of 3 feet: Sand';/!�Aidobe'Mr It ❑ Clay .❑ Peat❑ Sandy Loam -❑ Clay Loam,❑ Hardpan 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 flank or see ge pit permitted if public sewer is available within 200 feet,) l PACKAGE TREATMENT [ SEPTIC TANK [ Size _, - ______•------------ Liquid Depth ___ -- t { Capacity i Type Material__-- --- No. Compartments --...�...-=---- o P Distance to near st: Well _ Q _______________Foundation _________� __-_._ Prop. Line ._, __._./__-..._.. .L __ Length of each line--------- ---- Total Length ,_--- 0------...-•---- LEACHING LINE [ No. of Lines ______________________ ;� ` 'D' Box .__ -------- Type Filter Material j �l_ p I " -�---- �--------De Depth Filter Material ---- 1- --------•---------------------•- I Distance t nearest: Well ___________________---- Foundation ------------------------ Property Line. SEEPAGE PIT i Depth _____a�--___-- Diameter - -______ Number ________.�/_________--- Rock Filled Yes p'f No 0 l y ------------------ I „ 3 E ` !Water Table Depth --------------- Rock Size --- �c� -------- iDistance to nearest: Well _--_-_____�_� -------------------•-Foundation -______� -�.__-- Prop. Line ......s............ REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------ - Date --------------_-----------------) SepticTank (Specify Requirements) ----------------------------------------- -------------------•------------------------------ -----------------1--------------------------- Disposal Field (Specify Requirements) ------------ -------------------------------------- ---------------------------------------------------•--------------- --------------------------------------------------- _ ---------------- - ------------------- ---------------------------------------------------------------------------- ---------------•--------- - ---------- - 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 orkman's Compensation laws of California." Signed ---------------------- - --- ------ C- ------------------------------------------ Owner Title - ---- ----------- (If other an owner} t FOR DEPAitTMENT USE ONLY 101, APPLICATION ACCEPTED BY ------------------------------------------------------------ -•-- DATE ----------. -------- IBUILDING PERMIT ISSUED ------------------------ ----------------------------- -----------------------------DATE ----------•-------------------------------- ADDITIONALCOMMENTS ---------------------------------------------••----------...---------------------------•------------- ------------------------------------------.-------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- # ---------------------------------`----------------------------------------------------------------------- - - --------------------------------------- -- - ------------'--- ---------------------------- -------- -- -- -- ------------- Final Inspection by. Date _ ". ' T 4 SAN JOAQUIN LOCAL HEALTH DISTRICT tip.. E. H. 9 1-'68 Rev. 5M.