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T FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ------------------------ ---- {Complete in Triplicate) ------- -------------------------- - 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 compliance �with , County Ordinan e No. 549 and existing Rules and Regulations: �a �c CENSUS TRACT JOB ADDRESS/LO ON _----- -- - -------------------- ----- -------Phone ------ Owner's Name ------------------------------ ----� --- -- -� --- , Address ... City ----.-----------------------------------------------•------•------ --•-•---- - // Contractor's Name -- ------------ License Phone F Installation will serve: Residence ❑ Apartment ouse❑ Commercial ❑Trailer Court !E] Motel ❑ Other ------------------------------'.------------- Number of living units------------- Number of bedrooms ---3-__--Garbage Grinder '------ _"'" Lot Size __="'r________________-----------•- Water Supply: Public System and name ------ ---------------- -------------------------• i--•- Private ❑ -------------.-- -------- E Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy LoanY�}--Clay Loam Hardpan ❑ Adobe-F-1 Fill Material ---------- If yes,type ---------------------------- r (Plot plan, showing size of lot, location of system in relation to wells, buildi.ngs, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if�pub,1ic sewer is available within 200 feet,) F PACKAGE TREATMENT [ 3 SEPTIC TANK'[ ] Size----------------;----- ----------- ---- Liquid Depth ------------------------ 4 ril�9–C - No. Compartments ____________ _ Ca acit TYPe -------------------- a W Distance to nearest: Well --------_ Q� -----•—:Foundation _!-- ------ ----- Prop. Line --------•---- ----- 1- LEACHING LINE [ ] No. of Lines -------�------------- Length of each line____- Q Tota! Length -------------- LEACHING ---------- ------- ,� t `D' Box .___________ T e Filter Material 4 ' ,Depth Filter Material __--_"________________._____..___...___..-- i Yp ----------' I ' Pro a Line Distance to nearest: Well ---------------•-------- Foundation.-___--------------- p rtY ------------ s o .. SEEPAGE PIT [ I Depth ____- "-- Diameter ________________ Number ________------------- ---- Rock Filled Yes ❑ No .� T'! Water Table Depth ------------- -------Rock Size ------------=------------- Distance to nearest: Well ----------------- ---- -. -----Foundation -------------------- Prop. Line --------- ------------ -) T t REPAIR/ADDITION[Prev. Sanitation Permit -------------------------------------------- Date -------------- - ----------- ---- Septic Tank (Specify Requirements) -----------------------------------I---- -------------"---- ------------------------------------------ r - - Disposal Field (Specify Requirements) --------------------------- -------------------------------------------- ----------------- ----------------------------------------------- " ---------- ----------------------------------------------------------------------------------- ----------------- -------------- ------ ----- ------- -------------------------------------------------------------------- ------ (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 f as to7beAubject to Wo an's C m ensation a sof California." Signe --- -------- Owner ----- i ----- Title ------------------------------------------------------------------------ - - - - - - -------------------- - (lf other than owner) FO D AitT T U ONLY APPLICATION ACCEPTED BY --- - ---- - -------- ----------- -- =-------------- DATE �f-- Z �"- ----- --- -------- -- - BUILDING PERMIT ISSUED ------------------- -- -------------------------DATE ADDITIONAL COMMENTS -------------------------------- ------------ ------------------------- -- -------------------------------=--------------------------- - ---------- --------------------------------------------------------- ----------------------------------------------------------------------- --- - ------- -- - ------------ ------ 67 ----- Final Inspection b Date -- - - --------- P Y SAN JOAQU N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M