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FOR.OFFICE USE: ` APPLICATION FOR SANITATION PERMIT •-•-- .[Complete in Triplicate) Permit No. -.S____ Date Issued __________________________________________--------------- This Permit Expires 1 Year From Date Issued Application is hereby made t 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 Pr 4inance No. 549 and existing Rules and Regulations: JOB ;ADDRESS/LOCATION - Xz -------- -------CENSUS TRACT -----------------------•-• Owner's Name -------------------- -- ------- — --------k ------Phone ------------------------------------ Address ----------------- - -- ---- ----- ---- --------- -- - --------- �-�-��=-C�.—•.City -- /.� Contractor's Name License ,71— ` fir Phon - --' . Installation will serve: Residence partment House❑ Commercial :❑Trailer Court I❑ Motel ❑Other ------- ------------------------ Number of living units:.------- Number drooms --;?-_.Garbage Grinder __.__._._ Lot Size Water Supply: Public System and name __ ❑ �`� --------------------------------- -------------Private Character of soil to a depth of 3 feet: Sand[] Siff❑ Clay ❑ Peat ❑ ISandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobeVFill 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 tank'or seepage pit permitted if public sewer is available within 200 feet,) ' v PACKAGE TREATMENT [ ] SEPTIC TANK Size____________________'-__-_-_____.____________ Liquid Depth ____----_-____________________ Material________-__ _ No. Compartments _________________Ca acitY -------- --- - -- Type j _ Distance to nearest: Well -----------------------------t-j__Foundation ---------------------- Prop. Line ---------------------- LEACHING --------- ------ --LEACHING LINE [ ] No. of Lines ------------------------ Lendfh of each line___ _____________-_.._____ Total Length ,_____-_-_-----------_-_-.__ 'D' Box ------------ Type Filter Material "---- :Depth Fifter�Material -------------------------------------------- 41 1 r �VV . Distance to nearest: Well ---------------W- --- Foundation ----------------%------- Property Line ----------------_-_-- SEEPAGE PIT to ' Depth ------------ Diameter __-___=:_j_____ Number _ Rock Filled Yes No ------------------------ -- a +,__INrater Table Depth -a-------------------- Rock 5ize --------'- { -:-------•--•- Distance to nearest: Well --------------------- ------------------Foundation ----------"'____-- Prop. Line ---------------- REPAIR/ADDITION(Prev. ---------------REPAIR/ADDITION(Prev. Sanitation Permit# ________________________________,- Date ---------------------------------- Septic ___________-_---_--__ _Septic Tank (Specify Requirements) --- - - ----- --- ---- .-------------- Disosal Field (Specify Requirements) , - i �• y r � ----------- = ;r, k --- --=-------------------------------------- -- - --------- ----------------------------- ----------------------- -------------------------------------- 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: "1 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." Signed ------- --------------------- _-- Owner BY --------- ----- --- ----------- ------------- Title ------ �'�' ---------- [If er t an owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------- ---------- DATE T-15_ 71;) ----•- BUILDING PERMIT ISSUED -- f------------------------------ DATE ---------------------------------------••- --- ----------------------------------------------------- -- ADDITIONAL COMMENTS ------------------------------------------- ' - . F------------------------------ -------- Final - ----- ---- - - ---- ina Inspection by: .- ' ------- -------.Date ------------------------------------------ • SAN JOAQUIN LOCAL HEALTH DISTRICT ' -Ilk C E. H. 9 1-'68 Rev. 5M .: