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FOR OFFICE USE: F , y APPLICATION FOR SANITATION'-PERMIT - ---- --------------- --------------------- Permit s (Complete in Triplicate) ------------------------------------- t 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: ryt L -- � a -----------------------------CENSUS TRACT ----------------- JOB ADDRESS/LOCATI: ._ f . � -.. ` Owner's Name ----- --;----------�-------------- ---�-�---�-^------- - ,P hone ----------,�---"-/'----�-- -r--'- ------tom----------`----- - Address ------------------------ ---Qv ----- ---- --------_. CitY ._ - Lte -;-------- -- -------•------- Contractor's Name ------ -- - -- --- License Phone ---- --=-------- Installation will serve: Residence tApartment House 0.-Commercial Tr ile Co rt❑ -. - Motel ❑Other '-------------------------------------------- Number of Living units;---------/Number of ng! oms -----.--/-Garbage e Grinder A�_:3-_____ Lot Size --- �� --`- r -------- -------- -- ---------- �1 Water-Supply, PublicS stem and name _______ '__. _ d'�. _____________Private PP Y Yp ^y$ y Y=�_ -.. 0-- Character of soil to a depth of 3 feet: Sand' Silt Cla Peat❑ Sandy Loam ❑ Clay Loam ❑ N F 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: I (No septic tank or seepage pit permitted if public sewer is^available within 200 feet,) PACKAGE TREATMENT [ ] ` SEPTIGTANK [ ] Size------------------- -••--.-------- --:-------- Liquid Depth ------------------------- - Capacity --------------- TYPe -------------------- Material-----------------------No. Compartments ------•-- ------------ i Distance to Foundatio _--------------------- LEACHING ____ ______________ Pro Line ___._____.______:._:' nearest: 'Well = - P'. -'-----'--- Total Length ----------- `.... LEACHING LINE [ ] � No. of Lines _________._ Length of :each fine______________°_ ._ _.___ -,----------- Len 9 ' 'D' Box ------ _ .:_ Type Filter Material '____________________Depth Filter 'Material = Distance to nearest: Well ------------------------ Foundation ------------ ------ Property Line. -----------.--------•_-- SEEPAGE PIT [ ] # Depth ------- -- - ------ Diameter. ---------------- Number ------------'----°---.---- Rock Filled Yes ❑ No ❑ r. ` Water Table Depth ---------------- -------------------------------Rock Size "_._________ Distance to' earest: Well ----------------------------------------Foundation ---------------__ Pro Line -------_------------ r F , REPAIR./ADDITION(Prev. Sanitation Permit d# ------------------------------------------- Dates �--------------------1 ` Septic Tank (Specify Requirements) ------- ---- --- = =--------=-------•---------------------- • Disposal Field (Specify .,.--------------------------- Dis Requirements) J � � P P Y Re q '� ------------ ----------------- ----------- ,_ --------------------------- ---- .----------------------------- ------------------------ ------------------------------ ------------------------------------------------ - - - I ,(Draw existing and required addition on reverse side) I 'i 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,- I sed agents signature certifies the following: k ; "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." a Signed ------------------------=---------------- -- ------------------ ------------------------------..Owner By --`------------------------------------------------ Title - F } -------------- t (If other than o FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _. --------------------------------------- --------------------- ----------- DATE ' -- - BUILDING PERMIT ISSUED ----- --------------------------------------- DATE ------------------- --- --- ----- ---- ADDITIONALCOMMENTS - ------------- ---------------------------------------------------------------------------- ------------------------------------- -------------------------'• ----------------------------------'--------------------------------•--------------------------------------- ---------------=----------------------------------------------------------------------------; -------- ------- --------- -----Allf - -- ------ - Final Inspection by: -- ____-- _ Date ---- �' SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M