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FOR OFFICE USE: 3 J APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. -��-__:��.. ---------------- -- - t r 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 wit County Ordinance No. 549 and isting Rules and Regulations: p JOB ADDRESS/LOCATI '�� CENSUS TRACT ------------_------_--- Owner's Name --------- `----�— '------- =yy'� Phone ,�1 / ------ --- Address ---------------- -f-�/�� a r- City _ ------------------------- ��AContractor's Name -- ------ ,:____ Wit______ _ _ _____. _ _ _ ---------------License # 6- l?' ___ Phone Installation will serve: Residence J (Apart ent House f❑ Commercial []Trailer Court !❑ Motel ❑Other -------------------------------- •--------- y Number of living units:____ Number of be oms _______Garbage Grinder._ Lot Size - /____� � _ - w------�-' ------------------------------------------------------------ i 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 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' Size____ ��----------- liquid Depth ----�4 --------------- Capacity/Jd74�4 Type 1x44_4_9A14_ Material--- No. Compartments _-_ l Distance to nearest: Well ------- l' __ p. __....Foundation _ ___4'_ ________ Pro Line ---- _________ LEACHING LINE ,k No. of Lines -----A-------------- Length of each line-----ZIS- ------------ Total Length __--_--_--- 'D' Box -_. _-__ Type Filter Material 0_ _ Depth Filter Material __!Q_r.0.......................... Distance to nearest: Well/Y4 Gcf Foundation _/C'_............__ Property Line __ .......... SEEPAGE PIT Depth c-.)TN ------------ Diamcetter+.�. _�*...._ Number -___-Z__--__-___--_-_- Rock Filled Yes * No C] Water Table Depth .......... .......p!J --------------------------------Rock Size ------------------ Distance to nearest: Well --N`_-: _.9.L195f-------------Foundation --- — --------- Prop. Line _.._ ........ REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ______--____________---------._-__) SepticTank (Specify Requirements) ------------------- ------------------------------------------------------------------------------------------T----------------------------- DisposalField (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- -------------I----------------------------------------------------------------- --------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------- ---------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 other than owner) FOR DEPARTMENT USE 2NLY APPLICATION ACCEPTED BY r ----- -- -- - --- - ------ --------- ---------- DATE F '" / BUILDING PERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE -- ---------------------------------------- ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------------- -------------- -------- ------------------------------------------------------------------------------------------------------------------------ ------ ---------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------- ----------- ;;74-- __ __ __ _ __ ______ ____�4_. _ _ _ _ _ _ _ ____ ____ _ .�--_-_ Final Inspection b }_ a� _' - Date __ �/ ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M