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FOR OFFICE USE: f APPLICATION FOR SANITATION PERMIT ------- ------ - � � Permit No. --------------------- ------------------ - (Complete in Triplicate) -- +► ( - �_- ._ ___¢��._ ------------------ f 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 existing Rules and Regulations: JOB ADDRESS/LOCATION /.___ .�_�,�jU____�__�-�� //,�,�_--____,� �jj�,_--__CENSUS TRACT ___.____________________ Owner's Name --------h -,� - {'' ��------------------------------------------ ----------------- -Phone Address ---- C` -----�------ G'--_,k! F_ - --. City _..:�!!Y --� - ---- --- ----------- ----------------- Contractor's Name ------- __ �' -�-�-�-'�----/'�-C'-/�--�-'�--''-" ---------- -------- -----License Phone Installation will serve: Residence 0 Apartment House�❑ Commercial:❑Trailer Court i❑ Motel ❑Other ------------------------- i Number of living units:---- Number of bedrooms . _-_--Garbage Grinder/_ e--- Lot Size Vii%_ __ f/C-_-__-------. Water Supply: Public System and name ---------------------- ---------- - ------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe j 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 4{J Size__' _ ' . . -_____ Liquid Depth 6,�V--__.-_-______ Capacity tQ_ ----- Typer 4K Material_ y?! _r.___ No. Compartments Distance to nearest: Well ___._`� ------------- --------Foundation 14% Prop. Line C,............ LEACHING LINE No. of Lines __________ ____ Length of each line-_- '` - g -��''---------------- Total Length ,/_��-----------•---- 'D' Box)/�!,'�_ Type Filter Material / 46/_ Depth Filter MaterialZe_-P-__-------------------------- f Distance to nearest: Well __��r ____________ Foundation --------- Property Line SEEPAGE PIT Depth __ - -------- Diameter -------- Number _-__------------------------ Rock Filled Yes, No 0 Water Table Depth ------fQ 6 ------------------Rock Size --- Distance to to nearest: Well _.__/ ____________•Foundation __ ------- Prop. Line _..t _-.!........... REPAIR/ADDITION(Prev. Sanitation Permit# -------_------------------------------------ Date -____________-__-__-___-_----_____) , Septic Tank (Specify Requirements) - ----------------------------------------------------------------- ------- ------ Disposal Field (Specify Requirements) .------------------------------------------------------------------------------------------------------------------------------------ ----------- ------- -------------------------------------------------------------------------------------------------------------------------------------------------- ------------------=--•--------•------------ ---------------- --------------- ----------------------------------------- ------------------------- ---------------------------------------------------------•-------------- (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------------------- --- ----- -- ------------------------------------ Owner By ------------------------- "' Title - - (If r than own G l �---- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------- c-----==----------- =-------- ----------------- DATE BUILDING PERMIT ISSUED ------------------------- ------------------------------------------------------------- ... --- ' " -------DATE ---Y---//------- -C----------------- ADDITIONAL COMMENTS ------------------------------ --- ------------------------------------ ----------------------- ------------------------------------- ----------------------------------------------------------------- @ -Final Inspection by: -------------------------------- Date ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M