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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT t� ........ ......................__. ... .....,. Permit No.l.� .... (Complete in Triplicate) Date Issued..�.+�:.7.��.. ..................... -__"-.... ................. This Permit Expires 1 Year From 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/LOCATI ....... ...................................CENSUS TRACT .............. . . . ..... Owner's Name......._....:.. Phone:. OF Address..... ... C --- zip.................... Contractor's Name".:..:.. ' Phone . ; . Installation:will serve: esidence ( Apartment House ❑ Commercial ❑ Trailer Court ❑ ' otel [❑ Other Number of living units.....:....::..Number of bedrooms...*'. _:-_Garbage Grinder............ Size --- .� � :. Water Supply: Public System and name._...: .... ... ....,,......... .. ....... .Private Character of soil to a depth of 3 feet: Sand ❑ Silt d Clay❑ Peat❑ Sandy Loam Q Clay Loam �k. 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 1 _ PACKAGE TREATMENT ( j SEPTIC TANK ( j` Size... }} X. -/:-r--....-: . ... ...Liquid Depth.."- ................... Co pacity,1r9017,---Type_:.............Material..... ...No. Compartments'.-V., ...P_ Distance to nearest: Well......1 1W..................................Foundation..... : . ..........Prop. Line.--- ..�........ .... h LEACHING LINE ( j No, of Lines---- �d�+.... __ Length of each 1' E►--.-:> .:......--..Total CeAV r'Pth ..'rl ... ...................... 'D' Box. Filter Mate(ial_...... Depth Filter Material:..:,it .. .:. . .....:....... ;. ,Distance to nearest: Well.....!..fp.,. •• ---- undat•ton- ..........--....... .. ..Property Line.................................... SEEPAGE PIT Depth._..� �.._..Diameter.....$j.... _._..Number_.:.... ................ k Fitted Yes No Water Table Depth:.... .. ...........................:Rack Size.-...._. .....•... = - ` Distance to nearest: Well...........I...... --•.................,..Foundation...:.: ..:.. --.......Prop. Line_. ......._..... ......- REPAIR/ADDITION (Prev. Sanitation Permit#...... : ...... . . . . ... .... ......Date.......... . ........""..------------_----- Septic --- ----_-. -Septic Tank (Specify Requirements).......... .... .. ...... ...............................-•--•.............................. ............ ............. Disposal Field (Specify Requirements) ..I ---••- -- ......•..= - .............................................................._........................................... (Draw existing and required addition on reverse side) I hereby certify that 1 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 licensed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, t shall .not employ.arty person in suA manner as to become subject to Workman's Compensation laws of California." Signed......... � ..... ..Owner BY.. - -•- ---�.I .. ..Title..... .,... .........._...._....-•-•------.......... ... .. ....... If other than owner( FOR 'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....... t!"1. ......................... .......................................DATE .......J► .. . - .. DIVISION OF LAND NUMBER............................. DATE.........;.....................,-.. ..7......... ADDITIONALCOMMENTS_.............. ..................................... ....••-• --.................... .............-• -- .......:. ................................. ..................:.......... .........._...............................................e.'; ., ............_... --.....................-----_.... .. ... ......... ..•• •.._.. . FinalInspe ton by:......... .. .... ..... ........ ..... ....•-•••........---:.. ..••... ------•---..... ......... ...... .....Date------ - ----- ----....... ............... 'EM 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677 REV. 7/76 3M