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• �,fOR OFFICE USE. APPLICATION FOR SANITATION PERMIT —7 Permit ° (Complete in Triplicate) ------ --------- P Date issued _ _ This Permit Expires 1 Year From Date issued Ation is hereby made to the San Joaquin pplicaed. This application Local Health District for a permit to construct and install the work herein ` describ .is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 2`(( —(t'J- { - -A - CENSUS TRACT -_3 - ------ ----------- JOB ADDRESS/LOCATIION .------- i - r Phone Owner's Name ------ t6. di Address ------------------ ©av----- ----------------------------------.. City - Contractor's Name -- License # ------------------------ Phone ------- -----------------•-•-- - -------------------------- --- --- - - - - ------- ------- ------- - Installation will serve: Residence kA Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ------------------------------------------- Number of living units:_--._�_ -- Number of bedrooms ---__-___-__Garbage Grinder --------- __.__-_._-- Lot Size ""--- -- --------Private- [ f Water Supply: Public System and name ______________"__-___ - -•---------------- --- - _ Char atter of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam I Hardpan ❑ Adobe rif Fill Material ------------ If Yes, type ---------------------------- i (Plot plan, showing size of lot, location of system in relation to' wells, buildings, etc. must be placed on reverse side.) p seepage pit permitted if public sewe is available within 200 feet,) ,, N NEW INSTALLATION: (No septic tank or � ,. . „ SEPTIC TANK, Size--- _ --------------------- Liquid Depth ---- -•--- ------••-- V� PACKAGE TREATMENT [ ] N lT aa-t-__ Material ' I� --- No. Compartments _-----"�----------- Capacity -, ------- Type - �-- - -- t 70 ---------- Prop. Line --- - -o-_--,------ (-fl Distance to nearest: Well ---------- ---------------Foundation ___"_16 No. of Lines ------: --- Length of each line--------q"0 ------ Total Length - - •-----------.. LEACHING LINE [ ] i� 10 YZ]C:-----Depth Filter Material ------0- 'D' Box '.��----- Type Filter Material ---- - Property Line -----.5- ---------•------ Distance to nearest: Well------- 4- Foundation --- p SEEPAGE PIT { ] Depth -------- ---- Diameter ---------------- Number -------------- -------- Rock Filled Yes [I No 0 Water Table Depth ------------ ------------ --------Rock Size -------------------------------- Distance ----------------------- ------Distance to nearest: Well ----------------------------------------Foundation - ------------------ Prop. Line ) REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------- � Septic Tank (Specify Requirements) ---- ---------------------------------------------------------------------------------------: Disposal Field (Specify Requirements) --------------------------• - ------- ------------------------------ - ---------------- -- --------------------- ------- --� --- - --------l ---- ---------- ------- ----- {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 l 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 taws of California." l Signed --------- -=- ----------------- --------- -------------------------------------------- Owner ----- ,,,_ ,�f� ----------------------------------------------- Title -------- -- -------------------------- - ----------- (If other than owner) FOR .DEPARTM US LY DATE ---- �o - 7� APPLICATION ACCEPTED BY --------------------- ------- -- -------------------------------------------------- ---- -- ----------- - -- BUILDING PERMIT ISSUED ---------------------- ------ ------------ ------------------- - --- ------- ------------------DAT - ADDITIONAL COMMENTS -------------------- ------. ------------------------ ------- -- --------------------------- i ------------ ------------------------------------------------------------------------------------------------------------------------------------ - ------- - ------ - ----- ----- - ��—7 l --- - --- ------------ ---------- --------- ----------- --------- --------- -------- ----------------------- ---- Date ----- ------- - --- --� --------------- Final Inspection b ----- SAN JOAQUIN LOCAL HEALT STRICT G � E. H. 9 1-'68 Rev. 5M.