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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT g ---------------- - --------------------------- –� Permit No. _�_� ,! (Complete in Triplicate) - ---------------------------------_-------_--------------- This Permit Expires 1 Year From Date Issued Date Issued _f-7ad-_ Z- 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 Rules and Regulations: JOB ADDRESS/LOCATI "'� ' ' /3 - ----._CENSUS TRACT --------------_---------- Owner's Name �� --------Phone ------------------------------------ Address ------- ---�� ` f�4------.... City --------5i ------------------------------- ------ Contractor's Name d -`--- '- --- ------.License # --- Phone ----------------------------- Installation will serve: Reside celi Apartment House❑ Commercial ❑Trailer Court :F-1 Motel ❑Other ------ - --------------- Number of living units:------ ___- Number of bedrooms --.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 .Y Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material -----:______ If yes, type ____________________________ r) (Plot plan, showing size of lot,"location of system in relation to wells, buildings, etc. must be placed on reverse side.) Zu NEW INSTALLATION: " (No septic tank or seepage pit permitted if public seer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK' Size _ _ _.__-- Liquid Depth __________________ � ______- � YMaCapaci- Ma terial- —__ No. Compartments -__ _ .:.._- �q Distance to nearest: Well _______________ ----Foundation ------- Prop. Line .__-__S.____�___ i LEACHING LINE [ No. of Lines ____ ___________ Length of each line___.___ A -_-__ Total Length _____cam_`G� --------- 'D' Box ______ Type Filter Material ------- _-_Depth Filter Material -------- " ____._.............._ Distance to nearest: Well _________7Sa_______ Foundation ---- _- _�_______ Property Line _____-r............. SEEPAGE PIT [ ] Depth __________________ .Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth ------------------------------------------------Rock Size ---------------------•--•------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --------.------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------------_--------) { SepticTank (Specify Requirements) ----------------------------------------------------------------------- ----------------------------- ---------------------------- DisposalField (Specify Requirements) ---------------------------••-------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------- h ------------ --------------- (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: "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 Wo an's Compensation laws of California." Signed ------------------------- ------ ------ Owner. - BYTitle -- ------------- --- ' -------------------------------- ------ (If other than owner) , FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY -- = ....... DATE _. - ! ------------ BUILDINGPERMIT ISSUED --------------------------------------------------•---------------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS -------------------- -- ------------------------------ ° = -------------------------------------------------------------------------------------------------------=-------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ------------------------------ -------- --- --- ---- Final Inspection by: --------------------------------- -------.Date f ? --------- SAN JOAQUIN LOCAL HEALTH DISTRICT r E. H. 9 1-'68 Rev. 5M