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' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT :.............................. Permit No. ............ IComplet2 in Triplicate) -Date lssued .�................................................... This Permit Expires t 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/LOCATION ... ... .. ....................................CENSUS TRACT ..................... Owner's Name ...d -.. , Vo--------------..................•--................-,....----.............................Phone . 407................ Address . . .,�2 �._.... . .. City ..........._........_....................................................... Contractor's Name ....----•--- - _--- -------- -- ..........License # ...... ................. Phone .............................. Installation will serve: Residence Apartment Housefl Commercial OTraller Court 0 Motel ❑Other.--••-••••. •--••-•-----•.............. Number of living units:...------- Number of bedrooms�_..._-Garbage Grinder ......-_.... Lot Size .�}_. ` -r.................... Water Supply: Public System and name • ................ .................................---...............................................Private Character of soil to a depth of 3 fest: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam Clay loam ❑ Hardpan ❑ Adobe❑ Fill Materlal ............If yes,type............... ............ (� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse slde.1-^\' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,[ PACKAGE TREATMENT [ ] SEPTIC TANK I Size................................................ Liquid Depth ......................... Capacity -------------------- Type ------------------.. Material...................... No. Compartments •--•-•...._........... 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 ........................ I SEEPAGE PIT [ } Depth -------------------- Diameter ---------------- Number ..................... hock Filled Yes ❑ No (3 Water Table Depth ------------------------------------------------Rock Size ............._.. ............... Distance to nearest: Well ...................Foundation ..... Prop. Line I REPAIR ADDITION rev. Sanitation Permit# ----------------------------------.......... Date ------_.-_._.. ................... Septic Specify Requirements) .......................?r ........ . Disposal Field (Specify Requirements) ------ _ � •• ?!' ;�,)p J ................................... ...............•.........I............. . ••---------------- (Draw existing and required addition on reverse side) 1 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 Mules 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 becomesru*[ect to War on's Compensation laws of California." SignedY..- --• --------------------------------------.--------------------••--...... --- Owner BY --- -- • -- ----------------- Title(If other than owner) O Mt FOR DEOARTMENT USE ONLY APPLICATION ACCEPTED BY ----- -----•--- ---------------•------••-----------------------------••-•--------------------. DATE ..... `� = BUILDINGPERMIT ISSUED ----------------------••------------------.-.....------ ------------------------------------ --._DATE ..................................... ADDITIONAL COMMENTS -•------------••- • ---.._....__I......-•-- .. ----------•-••----•--•............... -----------...._.--------------- :------------------------------------------------------------------------------------------------------------------- --------------------------6------ -•--6 --•--- •• - - --- . FinalInspection by- ------- ----- - - -- -•-----------------...----r--•-•---------- -----...._.----•------- ------•.Date ..----•--•......_.........__. EH 13 2h 1-68 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3m