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FOR OFFICE USE: -' T - --------------I.- -_, ----------- APPLICATION FOR SANITATION PERMIT ` —?------ t (Complete in Triplicate) Per m it No: _-_--"__-- ----------- This Permit Expires ] Year From Date issued Date Issued -_!---------__ -- Application is hereby made to the San Joaquin Local Health District for a permit to construct described. This application is made in compliance with County Ordinance No. 549 and existing Rules a uct and install the work herein J08 ADDRESS/LOC TION .-.-._-- I an Regulations: Owner's Name ----- ---CENSUS TRACT ' Address -------- . ------------------------------------------ - ----------------------------------- ---- --- -------- --_- -- ' Phone -----•--------------- Contractor's Name ---------- city - c ' --_ Installation will serve: € � ----License # -- Residence�Apartment House-[D Commercial.0 Trailer Court ❑ Phone _ Q, Motel [Other-'-�-_-_ Number of living units:-__L ------ Number of bedrooms _-�--Garbage Grinder ------- --- Lot Size _---- . Water Supply: Public System and name Character of soil to a depth of 3 feet: Sand - - ---------- -- - - - ------- --Private El-------- - --- ----------------------- ❑ Silt.❑ Clay ❑ Peat❑ Sandy Loam Hardpan ❑ Adobe ❑ Clay Loam ;❑ ill Material -_-----_--- if yes, t Ji, (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc, must be laced o NEW INSTALLATION; p n reverse side.) (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ SEPTIC TANK ri 4 Size - ------------------------------ Liquid Depth Capacity .------- -------- T - Ype Material -------- No. Compartments ------1-1 to nearest: Well ---------- -- � - ----•_ LEACHING LINE Foundation ------------ --------- Prop; Line --.----------_ S [ No. of Lines --._ -------- Length of a ch line ----- -. - T w Total `Lenngth __- Q _ 'D' Box --- - --- -- - ---- Ype Filter Matepal _ �:--Z-- -- r __ epth Filter rMaterial ---Z ----- ...............to nearest. Well _---_-__ Il -- SEEPAGE PIT -- ---- -Foundation _- "ZQ__-------- Property Line ,�+------ ---------------------—�� DepthDiameterv1 -----------•---- Number -------------------------- - Rock Filled. Yes ❑ No ox rs�� Water Table`.Depth -------------- ( Rock Size Distance to nearest: Well -------------- - Foundation ----------- Prop. Line ------. RIEPAIR/ADDITION(Prev. Sanitation Permit# -.-_-_- ................................ Date �- Septic Tank (Specify 1 ' Requirements) e q -" ---------------------- Disposal Field (Specify Requirements} -- ------------------------------ ------ - -- -------------------- . 10 -K �! i ---- {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 becom ubject to Workman's Com ensatiion laws of California." Signed ----- ---- ��C.0 N BY ------- Owner -- (If other than owner) —� --- = Title - - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---/ _- BUILDING PERMIT ISSUED ----- - 1 --------------------------- DATE ---- ----------- - --------- ADDITIONAL COMMENTS _-----_---------- DATE -- ----- -------------------------- -- ------------------------ -------------- --------------------------------- ----------- ---- ------------------------------------------------ ---------------------- ------------------------- --- Final Inspection b --- ---- ----- ----- -- ---- ----- Y _. --- - - - --- ------ ------ ------.Date SAN JOAQUIN L CAL HEALTH DISTRICT _ E. H. 9 1-'68 Rev. 5M.