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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Compfetein-Triplicate) Permit No. --------------------------------------- --------------- This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549 and existin Rules and Regulations- - J08 ADDRESS/LOCATION _Z '_-_ _ ._ CE S TRACT _ ,I � , - Owner's Name L --- ----- ------------ ------------------------------------ -------------------Phone Address ------ _ ----'"L - Ci Contractor's Name --------- License # Phone Installation will serve: Residence KApartment House[] Commercial :❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- Number of living units:________ Number of bedrooms __3...Garbage Grinder -- Lot Size --- --------- Water Supply: Public System and name ----------- ----------------------•---------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ r 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.) { NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 1 PACKAGE TREATMENT { ] SEPTIC TANK' Size------- _ X_ ______________________ Liquid Depth -----T_--6 Capacity ___4)_-��..__ Type -__ �Materiai___C'r�^ � No. Compartments __ ............. Distance to nearest: Well -------?Q_ ________________Foundation ---/6 Prop. Line ---- ___--_________ LEACHING LINE [ j No. of Lines ______________ Length of each line_______k___-___-_ Total Length ___ -7_ f_____- 'D' Bo� ______ ype Filter Material _____Depth Filter Materiall_g_ ______________ ________ __ ___ Distance to nearest: Well -------- --Foundation ------------ Property Line. :_________ SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Numbe ----------------------- Rock Filled Yes ❑ No Water Table Depth ------------------------------------------------R6ckSize -------------------------------- Distance --- _'-__.____-_:___ __--_Distance to nearest: Well ----------------------------------------Foundat.ion - ------ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ____.-_______ ............. Septic Tank (Specify Requirements) --------------------- ------------------------------------------------ =-------------------------•---------------------------------- w � � Disposal Field (Specify Requirements) ----------- --------------------------------------------------- - :- !-- 1 - - - - ----------------------------------- (Draw existingand required addition on reverse side) _j 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 prformance of the work for which this permit is issued, I shall not employ any person in such manner as to became s Work an's Compensation laws of California." ' Si ned _ _ - r g - -- - --•--�-t---------------------------------------------------- Owner' _�• , , BY ------------------------------------ ------------------------------------- --- ------------------- Title -------- -------- -:'-(If other than owner) F0 DEPARTMENT USE ONLY APPLICATION ACCEPTED By,_--- - --- = ----- ------------==---=---------------- -'-- ---._. DATE - ---- ---------------- BUILDING -PERMIT ISSUED ---------------- ----------------------- ,._ ---------- ----DATE ADDITIONAL COMMENTS ------------- -------- -------------------------------------- ------------------- ----------------------- ------------------------------------- --------------------- ------------ -------------------------------------------------------------------- _- ----------------------------------- -------- -- --------- ----- ---------- ------ - Final Inspection by.C-- y ; -------------------------------------- - -------- - ---------- - ------- ----- ---- SAN:'J*OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M