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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT All)-- ---- Permit No. -------�=--------- (Complete in Triplicate) --- ---------------------A - -- jj f - Date Issued V. 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/LOCATIl ---�------ ----------------------------------CENSUS TRACT -------------- ----------- r Owner's Name r -- -- -- ' ---------------------------------- -------------------Phone ------------------------------------ Address ------------------------- --- ---/6?-------- ----------------- City - 1 'e'er l 'f'/------ Contractor's Name ----- . - ----------------------License #/_;�_A2,Jc' Phone - J. Installation will serve: Residence partment House❑ Commercial []Trailer Court ❑ Motel ❑Other-------------- -----+--------------------- / Number of living units:----I-_-_ Number of bedrooms _��______Garbage Grinder ��7--- Lot Size -12-3--- Water Supply: Public System and name -----------------------------------------------•------------------•--------------------------------------------Private KJ- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Materiaf�___ 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 ____-_______------_ -----_ 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 Material ___________________Depth Filter Material -------------_------.........._......... __._ �1 Distance to nearest: Well ------------------------_Foundation ------------------------ Property Line ...................... SEEPAGE PIT, [ j Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes 0 No i❑ Water Table .Depth ------------------------------------------------Rock Size ---•--------------------------- Distance to nearest: Well __________-__________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ________________________________ _ Date ----------------------------------) Septic Tank (Specify Requirements) --t - / J/ Disposal Field (Specify Require ents) 0-- Y < = -- --------------- --------------- lo- - -- -- --- ------ --------------------------------------------------------------------------------------•------- (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, l shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------------------------------- - ----------- Owner BY -- --- --- --- ---------- Tit)e ------------- --------------------------------------- (If other than ner FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- ----R--- ---- --6-u------------------------------------------ ----- -----• DATE ---�_//----Lbf-------------------- BUILDINGPERMIT ISSUED --------- ---------------------------------------- ------------------------------------------------- ---DATE ------------------------ ADDITIONALCOMMENTS ----------------------- ------------------------------------- ------------------------ --------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------- ------------------------------------------------------------- ---- -- Final Inspection b -------- -------------- - -----------Date I-��3 ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M