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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------------------- --------------- - (Complete in Triplicate) --------------------- ------------------------------------ pYear-'From t __. Date Issued _�...... ......... . This Permit Ex ires 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 compliances with County Ordinance No. 549 and existing Rules and Regulations: JOB ADORES -TIPN . ZIA" W 7J�t�,L �-------------- ---------------CENSUS TRACT --------------•----------- Phone --------------------- Owner's Name _ Address ---------- 1� -----•--- Cit- ---- Contractor's Name _ -•-- --- - --------- -----License #/—S/ ' ----- Phone ------------- installation will serve: Resid ce ❑Apartment House❑ Commercial :❑Trailer Court ❑ Motel ❑ Other ____ --- Number of living units:----_------ Number of bedrooms __r___Garbage Grinder ------------ Lot Size ----_------- 4 Water Supply: Public System and name ---------------------- ----------------------------------------------------------------Private EX Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam .0 Clay Loam[] Hardpan [y Adobe-E] Fill Material ------ ----- If yes,type ------------________________ (PI'ot 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,) PACKAGE TREATMENT PTITANK f S.Z �j r -r ---r�- ---- -------- Liquid Depth _11-1-------------------- Capacity ---------------- Ca actYoType. �_ Material No. Compartments -.-- ---------- . F Distance to nearest: Well --------- ----------------Foundation .__1 -___ -------- Prop. Line -_S______ LEACHING LINE [ No. of Lines ----�___________________ Length of each line------ ® -____._.. Total Length ----+!_b-jP__._____-._.___ 'D' Box _t-r�------ Type Filter Material :__��.. ______Depth Filter Material ----- - -----------------------•- i Distance to nearest: Well -----46-2---------- Foundation ------l_o------------ Property Line_ -------------- SEEPAGE PIT [ Depth ----- ---------- Diameter. Number _-._-----_�------------- Rock Filled Yes �] No ❑ _ J ------------------ a._..�. _ - Rock Size _�.1�__�'---3---------'- Distance to nearest: WelC =_:- �_�:_ f Water Table Depth "____�"�-------- ------ - - �__-.. Foundation tJ-- = Prop. tine REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------•---------------------) Septic Tank (Specify Requirements) ------------------- ------------------------------------------ -------------- --------------------------- - 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,OrdiState 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 laws of California." Signed -- -- -------------------------- Owner BY ------------------------------ - Title --- ----- -------- ---------- w (If other than owner) FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY --- _ -- ------------------------------------. DATE _-C._- -, _~ ------___--- i BUILDINGPERMIT ISSUED -------- ----------------------------- --------------------------- ---DATE -------------•----------------------- ---- ADDITIONALCOMMENTS --------------------------------------- ------------------------------------------- --- ------------------------ ---------------------------------------- ----- - -------- ---------------------------------- ------- --------------------------------------- ----- -------- - f k Final Inspection by: Date G SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M