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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------- -- < 11 Permit No. `� (Complete in Triplicate) ----------------------------------------------------_--------------- 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: nn c ADDRESS/LO TION 2�r' r1 ' [7-( S N------ ---------------------------------CENSUS TRACT -------------- ----------- JOB J -------Phone = � Owner's Name /� l- -� 1if k _ Address _ _ __ _.. ----------- _ � >-,�.�--�--- -��----- -�-�-41��i n�----- �=� . city lt .� Contractor's Name -_-_ ._. __ Phone -----�-•--,- ---------------------License #�_ _ Installation will serve: Residence RIXpartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other ------------------------------------ ------- Number of living units:-----j_____ Number of bedrooms _Z-------Garbage Grinder _NQ---- Lot Size -_ CASA¢ ___----------- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'66 Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material _4*--- 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,) pJ PACKAGE TREATMENT [ ] SEPTIC TANK,[ ] Size-----------------------------------.------------ Liquid Depth __--_--___ ............ v Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ...................... Distance to nearest: Well ------- ____________________________Foundation ---------------------- Prop. Line ...................... LEACHING LINE No. of Lines _______________________ Length of each line.--------------------------- Total Length ----------- ................ 'D' Box ------------ Type Filter Mat rial __________________Depth Filter Material __-_-_-_______-__-_.-_________-__-------- Distance to nearest: Well __________ _____________ Foundation ------------------------ Property Line -__.______-_____._------ SEEPAGE PIT [ ] Depth -------------------- Diameter _ ______________ Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance --------------------------- ---Distance to nearest: Well ----------- _-_________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# __.____--____V_______________________ Date ___-_--____________-__.-__________) Septic Tank (Specify Requirements) -------------------------- --------------------------------------------------------------------------- ---------------------------- Disposal Field (Spe ify Requirements) ----- ---------- - �/ _ � ` `' f" - / ' � c - '- - --- -f ----------- -/---1__. t>_1�F_"--------- r _r�f--'`=-!'_�'/'{-------------- - - - - --- ------------------------------------------------- - - - - - - -------------- (Draw xisting 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 WorkTan's Compensation laws of California." Signed - - Owner -�-------------------- Title --------- -------------------------------------------------------------- (If other than owner► FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY F j R =0' - DATE 1 -----------p-- ----------- BUILDING PERMIT ISSUED ---------------- --------------------------DATE ------------------------- ------ ADDITIONALCOMMENTS ------ ------------------------------------------------------------------------------------------------ ---------------------------------------------I--------- ---- -- -------------------- -- - - - ---- --------- ----- ------------------------------------- t ' Final Inspectionx - - �--t------ - ---- - - - ---------------------.Date -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M