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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- -------- - - - (Complete in Triplicate) Permit No:'2�,_J' ------------------------------- This Permit Expires 1 Year From Date Issued Date Issued __SaQ__Ez� 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 ' rCNSUS TRACTy Owner's Name - a ----------- c { x - Phone -- ----- -- --- Address -____ r R _ d _. City ----------- ------- --- ---•------- Contractor's Name ,/ '"r"-= '= .-----------------------------------------------------------------License # --------- Phone Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- n Number of living units:----I------- 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❑ Gay ❑ Peat❑ Sandy Loam 1�] Clay Loam ❑ Hardpan ❑ Adobe E] 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 [ l SEPTIC TANK [ ] Size-----------------------------------.____-__- -__ Liquid .Depth -------------------------- Capacity ------------------- Type -------------------- Material--------------------- No. Compartments -----------------.----- t� Distance to nearest: Well ____________________________________Foundation ______________________ Prop. Line ---_---------------- LEACHING _-___._- _-:_--___-_LEACHING LINE [ ] No. of Lines _____________________ Length of each line---------------------------- Total Length ----------- __-_-_ ........ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ------------ -------------------------------- Distance to nearest: Well _______________________ Foundation ------------------------ Property Line __________----____.---.- SEEPAGE PIT [ ] Depth _____ Diameter ---------------- Number ---------------------------- Rock Filled Yes 'Q No iQ Water Table Depth ------------------------------------------------Rock Size ---- --------------------------- Distance to nearest: Well _______________________________________Foundation ------------------.. Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) _ _____ _______________ _-._ .___-_ ____ __,,,____ - Disposal Field (Specify Requirements) _ ` u _._;___ ____ iT�7 }. _ _ _`__ _� f "_ ------------- --------------------------------------------------------------------------------------------•------------------------------------------------------------.----- ------ -------------------= ----------------------------------- ------------------------------------ (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 Oydinences, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents sign ure certifies the following: "I certl`fy that i the performance the work for which this permit is issued, I shall not employ any person in such manner as to " 'ect to rkm ' C pensation laws of California." Signed ---- -- -r- --- ----- Owner BY ------------ ---------------------------------------------------------------- ------------------------ Title --------------------------_ ----------------------------------------- (If other than owner) EOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - }_' y ,C --------- ---------•--------------------------------------. DATE- --6 BUILDINGPERMIT ISSUED ------------------------------------------------------------------------ ------------------------------DATE ADDITIONAL COMMENTS ------- ------------------------------------------- ------------------------------------------------ ----------- ------------------------------- ----------------------------------------------------------------------------------------- ------------------- ----------------------- - . - - - - - - - - - - - - - - - -{ - - ---- - - ---------------- Final Inspection by: �C' Date - -- ------------------ - ---- ------- --- ---- --- - - -- - - ---- ----- -- ---- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M