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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ^•� ---- ----- ----- ---------- - Permit No. _."[ �~.��.�-- ---- --- ---- -"-- - (Complete in Triplicate = ---------- -------------------------- Date Issued 1-3-x-1-'3 i This permit Expires 1 Year From Date Issued - ---- p a permit to construct and l the work herein Application is hereby made to the San Joaquin Local Health District inarnce No. 5.49 and existing Rulestalnd Regulations. =This application is made in compliance with County Ly � I JOB ADDRESS/LOCATION ` -----— --- -------------- 4� --------CENSUS TRACT .--- ------- Owner's Name ---- --------- ----- - --- ----------- --- ----------Phone ------------------------------------ Owner's Name -------- --------- City '". "-�''' . - -- - ` License # �_g _ -�'- Phone ------------------------------ Confiractor's Name ------ � � ------- 1 I Installation will serve: Residence [Apartment Housef❑ Commercial :❑Trailer_Court ;❑ Motel ❑ Other -------------------------------------------- -- Number of living units:-----/------ Number of bedrooms __--Y.Garbage Grinder ------------ Lot Size _..________ -•------------•---------- __ ----------------------- Private ❑� Water Supply: Public System and name --------------------- --- - ---- ------- ------------- - I Character of soil to a depth of 3 feet: Sand'❑ ilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam .E] Fill Material ------------ If es, type -------------- ------ Hardpan Adobe❑ Y (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 availablewithin 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK,[ ] Size------------------------------------------------ Liquid Depth -------------- Capacity ------ Type -------------------- Material---------------------- No. Compartments ---------------- P Y --------- - Yp , Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -------------=-------- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------- ------ % Total Length ----------------------------- V' til I 'D' Box ------------ Type Filter Materia! --------------------Depth Filter Material ---------------------------••---- pp Distance to nearest: Well ------------------------ Foundation --- Property Line ________----------.----- 1}z SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ----------------------- -- Rock Filled Yes ❑ No ,,C T, Water Table Depth ------------------------------------------------Rock Size -- -------------------------•--- i Distance to nearest: Well --------------------------------------- Foundation -------------------- Prop. Line ---.-----------..----- 0 REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------- ----------- Date --_------------------------------ ) 7 A Septic Tank (Specify Requirements) ---- -------------------- ------------ ------------- ----------------------------- ------------- -- --,<___"------------------------ V, Disposal Field (Specify Requirements) -----------------------------=-------------------------------------------- ---------------------------------- 0-10! k _"-----------------"----____----.___ _______________________ __ _ _____4---- __------ ,----I—________.____ _____________.____________`_______----------------- _______________________________________________________________________________.-___---___--_-__----_____--_____-_-___--_____---------.-_-------_--.-. (Draw existing and required addition on reverse side) I hereby certify that I have preparedf 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, 1 shall not employ any person in such manner i as to become subject to Workma ' Compensation laws of California." Signed ---------------- ------------- --- Owner ------ --- --------- --- ----------- - --- ----------- --- Title --- ----------------------------------- BY - --- -------- (If other than owner) FOR DEPAitTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------- --------------------------------- DATE ---�-`Ll_`-Z�--------------- BUILDING PERMIT ISSUED -------------------------- - -------------------------- DAT ADDITIONAL COMMENTS -------------------------- - - ----------------------- .. .-------=--- ------•----•----- ----- -------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- - I Final Inspection 6Y:_:_ Y: ---- - - ----- ----------------1% ----------------------------------- - Date - -- "------------ SAN JOAQUIN LOCAL HEALTH DISTRICT Of E. H. 9 1-'68 Rev. 5M �U