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i G' f >L&-Z& a FOR ACE USE: i�,�-�_-""' APPLICATION FOR SANITATION PERMIT _ Sq (Complete in Triplicate) Permit No. ____ ---------=------ - Date Issued __-__-________________ 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/LOTION ------_� " - - -- <d� _ ENSUS TRACT --------------- Owner's Name -- ------ ---------- --- _ ------------------------Phone Address ------------------------------ . oZ_ City ------------------------------•--------------------------------------•------ Contractor's Name ____�G=t__(�"�_ r� ��T(_El ____________ License # v ��__ Phone Installation will serve: Residence ❑Apartment Houseff-commercial ❑Trailer Court ;❑ Motel ❑Other --------------------------------------- r 7 Number of living units:_________ Number of bedrooms ___!________Garbage Grinder ------------ Lot Size'jl _- -__ �f ------------- Water _/..__-- Water Supply: Public System and name -------------------------------------------------------------------•----------------------------------------_Private Character of soil to a depth of 3 feet: Sand'19� ilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size___________________________________________ Liquid Depth --------------------------s Capacity -------------------- Type ------------------- Material---------------------- No. Compartments .-------- N 4 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 __________________________________________ Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ______-__._-_____-------V SEEPAGE PIT [ ] Depth ___________________ Diameter ---------------- Number ________________________ Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well _______________________________________Foundation -------------------- Prop. Line _____-__--_______--_- fb REPAIR/ADDITION(Prev. Sanitation Permit# ________-__.___ --------------------------- Date __________________________________) A, Septic Tank (Specify Requirements) ---------------------------------------------------------,------- Disposal Field (Specify Requirements) ----- �/ $-- e -------------------------------------- --- ---------- _ ' (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 subject to Workman's Compensation laws of California." Signed - --- --- Owner BY --------- ------------------------ T - - Title -------E ----- ----- ----------------------- - -- - ---- -- (If other than ned FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ____.___ ________ --DATE _ ._ _:___ __ ._ , 'b = - --------- BUILDING PERMIT ISSUED ----------------__ _ ______________DATE ______._____.__---_--________: ---------------------------------------------------------------------- ----------- ADDITIONALCOMMENTS ------------------------------------------------------------------------------ ------------------------------------------------------------------------------ F. _ ------------------- ------- ------------- - - - -- - --------------------- --- '}_ = ma Inspection bY ---------------------------------------- ----------------------- - ----------------- Date - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M