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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. This Permit Expires ] Year From Date Issued Date Issued ` ...` ..... Application is hereby made to the Son 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: T✓d JOB ADDRESS/LOCATION ._Lg - ---- ---------5�-- � ��. ---- -----CENSUS TRACT ------------ ------------- Owner's Name `j7�a/1/ E�---- "7_ P_._tr'f ci Phone --- -- Address ---------. City Contractor's Name - Phone --- ------.License # --. --_ � _�__ � -- --- _�(!��'�---- Installation will serve: Residence,kApartment House❑ Commercial :❑Trailer Court ;n Motel ❑ Other ------------ ------------------------- Number of living units:---/------- Number of bedrooms ______ Garbage Grinder :�_.___ Lot Size -_��_�_ -----____-----d_--- / a Water Supply: Public System and name _ C _____________Private ❑ Character of soil to a depth of 3 feet: Sand'[] Silt E] Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) `}f PACKAGE TREATMENT [ ] SEPTIC TANK 43C Size---- � Liquid Depth -a-------------- " Capacity ;21� ____ Type t'-� •� C'Material__.-cf��_rF^i�1o. Compartments Distance to nearest: Well ----- ----------------------Foundation Zo------------- Prop. Line .........5------------- LEACHING LINE [ ] No. of Lines _3------------------ Length of each line- d-__-___ ---- Total Length ___2__ � -. _____--- 'D' Box _� Type Filter Material �.,_7� Dept Filter Material Il // Distance to nearest:'Well _____ ____________ Foundation _________ Property Line -_- ---------- SEEPAGE -- --------- _ 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 --------------••-------------•_-_-) Septic Tank (Specify Requirements) ------ -------------------------------------------------------------------------------------------------------••---------------------------- Disposal Field (Specify Requirements) --------------------------- ----------------------------- ----------------------- - -------------------------------•------------- ------------------------------------------------------------I------------------------------------------------------------------------------------------ ------------------ ------------------- ------ ---------------------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, 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, 1 shall not employ any person in such manner as to bec a subject Ztorkm 's Compensation laws of California." Sign T----------------- `- - ----- Owner i � BY ---- ------------- Title -------- ------------------ (If other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y - -t - �0..... ------------------------------------- DATE ---- BUILDING PERMIT ISSUED -------------------- X, DATE ADDITIONAL COMMENTS --------------------------- -------------- -/ ------------------------------------------------------------------- - ---- - --------------- Final Inspection b 1 --__ p !Y - -- - ------ ----------------------------------------------------------Date ---- ` ��' '- ---------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT f E. H. 9 1-'68 Rev. 5M