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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- --------- ------ --- --- ------------------ --- Permit No: y (Complete in Triplicate) Date Issued "-------------------------------------------------------- This.Permit Expires 1 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:. I 1A JOB ADDRESS/LOCATION 90; ---------------CENSUS TRACT ------------------_----- Owner's Name ------- --------- �:.�x�t% Phone.-------------------------------- Q, -- Z AddressG - F ------- City ff Contractor's Name cJOi. License ------- Phone Installation will serve: Residence?�Apartment-House E] Commercial ❑Trailer Court ❑ j Motel ❑ Other --------------------------------- ---------- Number of living units:--- Number of bedrooms _- ��' :__Garbage Grinder -.--_ - ____ of Size ---- _--_----.-.. Water Supply: Public System and name ------------ ------t a ----- ---------- ---• Private ❑ Character of soil to a depth of 3 feeta Sand. Silt❑'` Clay❑ __Peat❑ Sandy Loam ❑ Clay Loam,71 w- p ❑ e Fill Material ------------ if yes, type ---------------------------- Hard an Adob " ` :. 'n s etc. must be laced on reverse side. (PI'ot plan, showing size of lot, location of system in relation to-vweEls, buildings,, p ) 1 I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK[ ] Size,, may- ----A.--------- ------------------ -----Liquid Depth -------------------------- Capacity -------------------- Type -------------------- Mateiial---------------------- No. Compartments ------_-.-------_---- Q Distance toi nearest: Well ----------------i---------------------Foundation---------------------- Prop. Line -_-.-----.---_--....._ LEACHING LINE [ j No. of. Lines -------------------- -- Length of each line-----------� ___.--------- Total Length -----------.-----------.-.-- 'D' Box ------ ----- Type Filter Material --------------------Depth Filter Material •_""---"----"--_----_--------_------------_.- Distance to nearest: Well _--- ----------__ Foundation ------------------------ Property Line. ------------------------ SEEPAGE PIT Det L 1 p -------------------- Diameter ----------------- Number ------- -------------------- Rock Filled Yes E] No 0 Water ;Table Depth ----------- Rock-Size- `_ - -------- 1 Distance to nearest: Well -----------------------------------------Foundation -------------------- Prop. Line ...................... .. a REPAIR/ADDITION.(P.rev. Sonitation,Permit_# ---------=---------------------------------- Date -----"--__----_------__---_---_--j SepticTank (Specify Requirements) -------------------------------------------------------------------------------------- ----------------------------------------------------- -..... Disposal Field {Specify Requirements) ------� 44-c----_4------ - -- --- - - 1E'�Y--- - - -- ------ - --------=`��-----= ---- -----------------------------------------=----- --i------------- ------ p � (Draw existing and required addition on reverse..side) I hereby certify that I have prepared this application and that the work will be doein 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 persona in such manner as to become subject to Workman's Compensation laws of California." Signed ---------- ------- --=---- = Owner BY . Title ----------- . --------------------- (if other tha o ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTS ----------------------------------- DATE ------ ------- P--t-- BUILDING PERMIT ISSUED ---------------------- --------------------------------------------------- -------------- --------------DATE ------------------------------------------- ADDITIONAL COMMENTS ------ `----------------------------------------------------------- ------ ---------------- ---------------------------- ------ ----------------------------------- -- - --------------------------------------------------------- ---------- - --------i--------,-------------------- ---------------------------------------- -------------------- ---------- ------------------------------ - Final Inspection by '� = ----------------------- ----- ------ Date r - ------ �✓ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M