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r , FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------- -- 7/ 1 1 5 3 ---- --------- - ---- Permit No. - -------------- ---------------------------- 0 _ (Complete in Triplicate) -- -- -- - - -2 f ____________________________ ---------------------- 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/L CATI 6 S �� ____CENSUS TRACT L Re Owner's Name _ _ r Phone - Phone-------------------------- Address ----- -- Cit � �_ ___________________License .....................Name ---- Installation will serve: Residence $Apartment House Commercial ❑Trailer Court I❑ Motel ❑Other -- --------- -------------------------- I umber of living units:---- Number of bedrooms _.___Garbage Grinder ------------ Lot Size -(:f Water Supply: Public System and name ----------------------•---------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'K Silt❑ 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 ithin 200 feet,) off► PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] ize---------------------------------------------- - Liquid Depth -------------------------- to Capacity -------------------- Type ---------- --------- Material--------------------- o. Compartments - ------ Distance to nearest: Well _________ _______-__-______-_______Foundation ____ --------------- Prop. Line ___.__.__._.___._____- LEACHING LINE [ ] No. of Lines ---------------------- Le th of each line---------------------- _ _ Total Length ----------- ---------------- bs 'D' Box ------------ Type Filter M erial ____________________Depth Filter aterial --____--___-_____-_____________,____.____ Distance to nearest: Well ______ ________________ Foundation ----------- ----------- Property Line _--,_-__________________ SEEPAGE PIT [ ] Depth ____________________ Diamete ---------------- Number -------------- ------------- Rock Filled Yes ❑ No i❑ Water Table Depth _____________ __________________________________Rock Size _ Distance to nearest: Well ____ -----------------------------------Foundat* ___________ ___-__________,____Foundat' n -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# __________ _______________________________ Date ___ ____ ----------------------) SepticTank (Specify Requirements) ------------- � -- ----------------------------------------- - ------------------------------------- ---------------------------•- Disposal Field (Specify Requirements) ________ _ ________ Z ._____-___ -------------------------------------------- Add- _____ __ ____________ --- ------------- ---------- _--- --e.-�----- -�'-c��--/�'�----I-/•�s----�_-_----- .�s ---, 4 /--�--/°C-------------- 1-G------------- -�Zi�►!' _ ---6=1` c.------------ ------- ---------- -ii ----------- -- ---- ------- (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'6$ents signature certifies the following: "I c X that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as tWl6ecome subject to Workman's Compensation laws of California." Signed - ------ -- - ---- --------------- --------------------------- Owner By ----- ---- ----�rth -- ------ -- - Title ------- ----- - --------- ----- - ` - - If othn owner) . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . --. _! _. la--_ -_ _ -___ ________________ -. -_ _,_. DATE --�� BUILDING PERMIT ISSUED _ __,_DATES -- - -- -- -- - -- -------- ---- - - - -- -- - - - - -------------------------------------- -- -- --------- ------------ -- ------ ADDITIONAL COMMENTS _ _ .-1 ----------------------------- - -- --- - - ----- - - -- ---- -------- ------- - ------------------ - - -- --- -- -- -- ---------- - -- -- ------ - -- - - -- - Final Ins - ---------------..Date ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M