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FOR OFFICE USE: APPLICATI&ii FOit SANITATION PERMIT ------------ ------ ------------- ----------- ----4 10 I (Complete in Triplicate) Permit No: -------------------------- ----------____ This Permit Expires 1 Year From Date Issued Date Issued I 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 ADDRESSAOCA N .__._/__� --- v---® ------------------------ .---[/- 1-:`-' .-.CENSUS TRACT -------------------- I Owner's Name - Phone Address __ - --So a--- -- f -- ----------------------------------- city � ------------------- Contractor's Name -------------License # ------- -:-------=------ Phone ------------- -------- Installation will serve: Residence ❑Apartment House-[] Commercial : railer Court ;❑ r Motel ❑Other Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------ Lot Size -__.___-_______-_______ -; Water. Supply: Public System and name _________________ __-____Private ----------------------------------------------------------------- '�- Gharaeter:ofaoid-to=a depth of-3 feet: .Sand- Silt fl-w�iXlay=0�P.eat Ej-; -SandyAoam O Clay:Loamr❑. -V Hardpan ❑ Adobe '❑ MI Material ____________iftype es, .Y .. Y ---------------------------- (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'[ J Size-----------_------------------------------------ Liquid Depth ______ Capacity -------------------- Type -------------------- Material---------------------- No. Compartments c LEACHING LINE [ ] Not of Lines Disance to nearest: ';Well ____________________________________Foundation ---------------------- Prop. Line __.-_________-.._.__- ---__. Length of each line-------- ------------------- Total Length ----------------- ---------- 'D' Box ---------- Type Filter Material ____________________Depth Filter Material -------- --- ____ `. Distance to nearest: Well _________----------�:�_�F.oundation -------_P.roperty Line --------------------- SEEPAGE ____._.______._ ...SEEPAGE PIT [ j Depth ---- Diameter ----------------- Number ____________________________ Rock Filled Yes .[3 No C) Water Table Depth - J -_--`-- __.-_---------Rock Size Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ..______.._.. ........ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- ------------ ) Septic Tank (Specify Requirements) _. ____-------- I - ----- ----------------------- _ ----------- Disposal Fiel [Specify Requirements) -_______'`T ___:_ __ _-_... --------�----4------- ---- ------- - - --------- ------ ------- -------------------------------------------------- (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 anti person in such manner as to becorg4flublie o rkman's Corh nsati.on laws of California." , Signed' �y -- -- r--------------------------------------- Owner BY -------- ------------------------------ ----------------- ------------------------------- --------- Title --�-----�-- --- ---- --------- -�-------- ----- - - ------------- � (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----4e�� - - ------------- - -. DATE "f I BUILDING PERMIT ISSUED ------------------------------------------------ -----------------DATE ADDITIONAL COMMENTS - -------- --------- --------- r - ---------. -------------- ••----r ------------------------------ �� --------/,.& - - .ina Inspection by - - --* -- -' _Date af SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 , 1-'68 Rev. 5M.