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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------ ------------------------------------------------- (Complete in Triplicate) Permit No - --------------------- Date Issued -------------_- This Permit Expires ] Year From Data Issued I Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATION ,7«o_- ........... ------ P}P.- ----------------------CENSUS TRACT --------------•----------• Owner's Name -----------------------------------------------Phone ---------------------------------•-- Address ------ 10City -- ---- --�--- ------ city `""' � Contractor's Name ._ ----- -- ------- ---------- -- ------- _License _��Phone ----------------------------.. Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ?❑ Motel ❑Other _ _ .- I . Number of living units_____________ Number of bedrooms ____________Garbage Grinder .___________ Lot Size --_ I --__ ---------------__________ Water Supply: Public System and name ----------------------------------------------------------------------------------------------- Private Character.of soil to a depth of 3 feet: Sand'❑ Silt[J Clay E] Peat E-] SandyLoam lay Loam ❑ IWO 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.) c NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size____L -------- -"-- - Liquid Depth ------------------ Capacity �-----�-_•T e.--.---------------- Material---------------------- No. Compartments P Y _._.--------------- YP P Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ------------------_- LEACHING --------- __..._LEACHING LINE [ ] No. of,Lines ______ ______________ Length of each line---------------------------- Total Length ------------ ................ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ----------------------------....-._--.-:_-.- k Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line --------------.--------- SEEPAGE _ --. _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 e# -------------------------------------------- Date ----------------------------_-__--1 Septic Tank (Specify Requirements) ---------------------------------ala --------------- - ------------------------------•--------------------------- /f Disposal Field {Specify Requirements) ----- ---------- ------ = - ----------------------------------- ----------------------------------- ------------- - --- ----- ---------------------------------------------------------------------------------------=--------------------------------------------------------------------------------------------- (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 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 Workman's Compensation laws of California." i Signed ---------------------------------- Owner BY ------- ----------------------------- ' - Title ---- ------ ---------------- i (If other than owner) FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY .-- r l ------------------------------------------------------------- DATE �`�--------7---�---------- + BUILDING PERMIT ISSUED ----- -- ----------------------- ---------------------------------------------------------=--------------DATE ------------------- - --------------------- ADDITIONALCOMMENTS ------------------------------------•------------- ---•--------------------------------------------------------------------------- --------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - - - - ----------------------------- - r Final Inspection by: ----- Date _.___�-r__��---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.