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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. {Complete in Triplicate) 01V-24— .................._. ............._......_....-... Date Issued This Permit Expires1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for 'a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: e ` ,�,-. i , r__ ..CENSUS TRACT JOB ADDRESS/LOC A ION I. .�• .... ..� . -------------------------- Owner's Name .........................Phone Address _.._..._...r-.4. ......jc.... .............. - ..... -• ---._....... City ........... .-.-.......•-•.• ... .. . . . . -- ................•-••.......... Contractor's Name ._ . _ .. License # .. ,. Y•-=- Phone. Installation will serve: Residence JApartment House C1 Commercial '[Trader Court 0 F Motel ❑Other ........................ -------- Number ------Number of living units ..... Number of bedrooms -- .......Garbage Grinder ...... Lot Size................................................. --.... .....Private Silt Ci Q ' Water Supply: Public'System and name...------------ - - - � ---- . •••_• . . •------...-- Character of soil to a depth of 3 feet: Sand ❑ ❑ y ❑ Pea t❑ Sandy Loam Clay Loam 0 Hardpan ❑ Adobe 0 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 tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK[ j Size..................................---------- ... Liquid Depth .... ..................... Capacity ..................... Type ................. Material---------------------- No. Compartments .................:.... Distance to nearest: Well ......Foundation ...... Prop. Line LEACHING LINE No. at Lines ____________ _________-- Length of each line-------.- -------------- Total Length ....__ ......... D [ ) _ ....Depth Filter Material N , D' Box Type Filter Material .. p .--.---•-----.....-•-----•...:.............. Distance to nearest: Well ................... Foundation ........................ Property Line ..._........... ...... i, SEEPAGE PIT l 1 Depth Diameter ................ Number ..._...._..._...-----..._._. Rock Filled Yes ❑ No ❑ ......:............ ,1XV Water Table Depth ..Rock Size --•-•••- Distance to nearest: Well ................................6.........Foundation .............--...... Prop. Line ---------------------- REPAIR/ADDITION ---------------------REPAIR ADDITION Prev. Sanitation Permit# Date ...:.............................. Septic Tank ISpecify Requirements) .............................................• a ,r,;... .:. ...........—.1 ......------.........----.WW........_..---- •--.... Disposal Field (Specify Requirements{ .&t.•4s�- -- . ..... ' ------------------------------------------------------------ ------------------------•-----••----- ......................................... -•-•------- (Draw existing and required addition on reverse side) 1 hereby certify that t 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 I as to become subject to Workman's Compensation laws of California." Signed ..................... ............. .... - Owner ... er Title . By . . = ----...... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ---- - -- - ----- ----- ---- ---••----------•------•-••-••. DATE ..ems ----- BUILDING PERMIT ISSUED DATE _...... ADDITIONAL COMMENTS -------------------•--------.....:----------•-=-........................ ... ............-------------------•-•.........I......._............ .........•........... ......... ........................ :..... .......................... ._ :....... .._..... .......... Final Inspection by: •...............................................Date . V. I SAN;JOAQUIN LOCAL HEALTH DISTRICT r - 7/72 3-X r. u Z3 24 ,--f R P., 5M -