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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. -. � -------------- __ ____ __ _____________ 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: JOB ADDRESS/LO -TI _ 7J-7 �- ----- --- --le------- -------------CENSUS TRACT -------------------------- Owner's Name -- - ----------- - - - - --- -- -- -- ----- -- ---- --- --------------Phone --- Address ��` City ---r - -- ---- ------------------- - - ---------- a .._.License # X�` --- Phone Contractor's Name ._____ l4 __ _ _ Installation will serve: Residen e TApartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other -----°---------------------- ,F Number of living units:.-__ ______ Number of bedrooms -------------Garbage Grinder ------------ Lot Size ____-.__-____________________________-___- Water Supply: ,Public System and named---- -----------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ CI E] Peat E] Sandy Loam ❑ Clay Loam;❑ Hardpan E] Adobe' ill 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 ______________________ v Capacity --------------------- Type --------------___ Material` - ------------ 'No;, Compartments ----- .......... Distance to nearest: Well ------ -------------------Foundation ------------------.___ Prop. Line __--_-___--- ........ LEACHING LINE [ ] No. of ,Lines -------------------------- Length of each line---------------------------- Total Length ______.__-_-___.________.___ t L , 'D' Box ------------ Type Filter°Material _________________Depth Filter Material ----------___ ------------------------------- Distance to nearest: Well --- ` _______.Foundation _.------------------------ Property Line ________________________ SEEPAGE PIT [ ] Depth _________________ Diameter )_____________ Number -------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------ -------------------- --------Rock Size -------------------------------- Distance to nearest: Well -----------------------------------------Foundation ______:____ -------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -----------------!-------------`-----------_ Date ---------------------------------- Septic ---------------_------------- --_Septic Tank (Specify Requirements) --------------------------------------------i Disposal Field (Specify Requirements) _____ _------- _-__ ____ __ _ ____ ___.--- --------------------------------------- t---V- _______ ___ _____________------------- -- ----- ------ --------------------------------------------------------------------- (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,•I shall not employ any person in such manner as to become sub* t to Workman's Compensation laves of California." _..� ------------------------ Signed -- - - Owner _ By ----------------- --- ---------SJ Titlet, - ------ ------- ------- -------- (If other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------------------------------------- DATE ---------------- BUILDiNGPERMIT ISSUED ------------------------------------------------------------------------------------------- --------------DATE ------------------------------------------- ADDITIONAL COMMENTS 0 _ 4 If k� - -- ----- ----- ---- --- ----- ------- - -- ----- -------- ------ - ---- = - ' --- - ---- ------------------ -- -- -- ---------------------------------- ------- -------- ---- _ - - = --------------- _ 70- Final Inspection by: ------ Date - -- - - -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.