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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --- ---------- ------------------ Permit (Complete in Triplicate) ----------------------------------------------------- Date issued_.1f.._:l_._r.._. -------------------------------------------------- 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 Countdinance No. 549 and existing Rules and Regulations: 1' JOB ADDRESS/LOCATIO 7� - CENSUS TRACT._ Name---��-- ---- --------------- --------- -------------------- ------------------ -- ------------Phone-------------------- Address ... . _. _ .- , p /y� --------------- --- 11�-- ----- --.. --- --- City (�/'-��" dip Contractor's Name-------- w __________________ �J__,..License Phone Installation will serve: Residence Apartment House.❑ Comm rcial Trailer Co rt ❑ Motel ❑ Other--- Number ther__Number of living,units-------.'-------Number of bedrooms-----2__Garbage Grinder----------__Lot Size__________________________________ __ _____.___.,.._. Water SIu pply: Public System and name---------------- - ------------------------ ------------------------- ------------------------Private 1. Character of soil to a depth of 3 feet: Sand E] Slit E] Clay E] 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 1114STALLATiON: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size---_-------------------------------------------------------Liquid Depth.__________________._______-�: Capacity ----TYPe-- -- -----------------Material--------------------------No. Compartments---------------------------------- Distance to nearest: Well---------------=----- ------Foundation-----------------.--------Prop. Line-------------------------- LEACHING LINE [ ] No. of Lines-----------------------------Length of each line-- Total Length.__.___.___.-_-----_ I 'D' Box------------Type Filter Material---------------------Depth Filter Material Distance to nearest: Well----------------------------Foundation----------------------------Property Line-----------------------------------. SEEPAGE PIT { ] Depth----------------Diameter_-----------------Number-------------------------------- Rock Filled Yes ❑ No❑ WaterTable Depth---------------------------------------------------------Rock Size---.-.------------------------------------------ Distance to nearest: Well-------------------------------.-----------Foundation--------------------------Prop. Line____________._._________._. REPAIR/ADDITION (Prev. Sanitation Permit#______________..______________.________--__------.Date._-_.___..___-.__________.__- ) Septic Tank (Specify Requirements)--------------------------___.__t _ -------- Di sq l Fi ld {S ecify Requirements)-- - � ,. ' - ----------- mac ----- ------ -±a_ ---- ° '"° ` ----------------------- - ------------------1- -----:---------- i (Draw existing and required addition on reverse side) I hereby certify that I have prepared ibis application and that the work will be done in accordance with San Joaquin County Ordina$ces, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed 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 become subject to Workman's Compensation laws of California." Signed- ----------------- ------ -. . `- --- f Owner B ---------------------------------T,� ---- --=— - • - - Title----- - N �(If otheethan owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ------------ - -------------------------- ------------------------------------------DATE.----- -14- 2. ------ --- --------- ---- DIVISION OF LAND NUMBER.--- ----'--------------------- -- --------------- ---- ------- DATE.------ ----------------------- ---- - ADDITIONAL COMMENTS----------- ----I--------------------------------------------------------------------------- --------------------------------------------------------------------------- -------------- - ----Date--- --Final Inspection bY FF1 13 24 4 SAN JOAQUIN LOCAL HEALTH DISTRICT M 21677 REV. 7176 3M