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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------�-Ift--------- ------ Permit No. (Complete in Triplicate) ____ ______________ This Permit Expires 1 Year From Date Issued Date Issued _4�__:/4___64_1 5 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 Ordinance No. 549 and existing Ryles and Regulations: JOB ADDRESS/LOCATION .---ALU_ --. ------- ----------------- .----CENSUS TRACT -------------- ........... Owner's Name ------2--- *�__--------------------- --------------------Phone -------------- Address -------- -- --- _ ___. City Contractor's Name ----- --- __ «------------� License # ------------------------ Phone -_______--____________________ Installation will serve: Residence ft<partment House❑ Commercial ❑Trailer Court ',❑ t Motel ❑Other ----------------------------- Number of living units:___._.I----- Number of/b2ecirpoms ---Z-----Garbage Grinder °' ____ Lot Size _ X_L__U_ U - Water Supply: Public System and name tom- ---------------------------- - Private ❑ i Character of soil to a depth of 3 feet: Sand'❑ /Silt❑ Clay-17 Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 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.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 26o feet,) 1, PACKAGE TREATMENT4 SEPTIC TANK![ Size---------------------------------------- ------- Liquid Depth -------------------------- Capacity --------- Type -------------------- Material------------------- -- No. Compartments U` Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- LEACHING LINE [ ] No. of Lines --------- -------------- Length of each line---------------------.------ Total Length _________-__---.--.-_--___ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------------------------_.__-- i Distance to nearest: Well ________________________ Foundation ------------------------ Property Line __________________-:_--. SEEPAGE PIT { ] Depth _________________ Diameter ________________ Number ---------__-----------.___ Rock Filled Yes ❑ No 0 Water Table Depth ---------------------------------------=--------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... Y REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------I SepticTank (Specify Requirements) ------------------------------------------------------------- ------- ----------------------------------.----------------------- ----- Disposal Field (Specify Requirements) --- -,-- o ------JS - ------------- --- .>' -------------------- ----------- - ------------------ --- - ------------------- --------------- -------------------------------------- --------- ---------- ---- lie_ ------- - ---- lie_ -0_I0- -- - ----- ______ ______ f - (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 ----------- ----------------- -------------- ------- - ----------------- other than owner) DEPARTMENT USE ONLY / r �— APPLICATION ACCEPTED BY -------- - ----- ----------------------------------------------------------- DATE ---- - � --------------- BUILDING PERMIT ISSUED --------- --------------------- -----DATE -----------------------_ -41 /ADDITIONAL COM ENTS __ - ---------------✓" r---- -------X-A-- -------- - - ---------------------------------------------------------------------------------- ---`-------------------- _ --- _____------------------------------------------------------------------------_Y--------__----------------------------- FinalInspection by: -------- --- ---------- --------------------------------------------Date 'lo. = ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M