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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �Q ,__ Permit No: (Complete in Triplicate) % f ----------------------------------------------- Date Issued 9=c This Permit Expires T Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 ------ �`S' - , - 0 --- - -- - CENSUS TRACT ----------- Owner's Name f -------� -------------------------- Phone Address -------- m Z Q .-- ------------ City --•----------------- Contractor's Name ------------ -- License Phone --------- Installation will serve: Residence ❑ Apartment House 10 Commercial .[]Trailer Court Motel ❑Other ------------------------------------------•- Number of living units;-----J----- Number of bedrooms _.-------Garbage Grinder---- Lot Size ------------------------------------- _ ----- Water Supply: Public System and name -_______ _.__ _ Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silto Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ;❑ Hardpan ❑ Adobe [Fill Material ------------ If yes, type ---------------------------- + r (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,) N 9 � .� PACKAGE TREATMENT [4--SEPTIC TANK[ ] Size_____�'�_____'C______________------------ Liquid Depth ___ ______________ � Material___ N_o. Compartments Capacity --- Type / _____ ____________�� Distance to nearest: Well ----- ------------------------------Foundation/0--f r-------------- Prop. Line 67_y------------- LEACHING LINE _--.-----LEACHINGLINE No: of Lines ___ __________________ Length of each iine':_Ll____________..____-- Total Length 6�--------- ------- D' Box --3-;,---- Type Filter Material __J��Gk_--- Depth Filter Material - --------------------------- - Distance to nearest: Well _______________________ Foundation ------------------------ Property Line ____-________---__._.... SEEPAGE PIT ] Depth Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ---------------------------------------------------Rock Size ----------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------- ----- Prop. Line ----------..---------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------11 Septic Tank (Specify Requirements) --------- ---- -- ------------------------------------------------------------------------------------------------ --------------- Disposal Field (Specify Requirements) ----------- ----------------------------------------------------------------------------------------- --------------- ------------------------------------- . -o -----'---!-------=-------- -- - ------------------------------------------------------------------------------------------------- --- �. ---------------------- - - ----------------- -- E �a (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;;* Rules and Regulations of the. San Joaquin Local Health District. Home owner or liven- sed agents signature certifies the following: p' "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 subj t Workm ' Comp sation laws of California." Signed ---- ----- ----- - ------ --- -------- ----------------------- Owner Title (If other than owner) R DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY _. ___ _ DATE _____. '�------------------- --- ----------------------------------- BUILDING PERMIT ISSUED ----- . ------------------------------ ---------------------DATE - ------------------- .1 ADDITIONAL COMMENTS = x ------------------------------------------------------------------- f ------------------------------------------------ - ---------------------------------------------------------------------:--------------------- ------------- ------ - ---- ------------------------------------------------------------------------------- --- --- -- - Final Inspection by: wv.' -----Date -- Q` ! SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M t. ,