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Y FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------- ------------------------------- - --------------------- (Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date Issued 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: JOB ADDRESS/LOCATION . '__ ' -'____I c1�_ _ -f� _ _�_ ENSUS TRACT S _ ______________ Owner's NameL� ------ -------------------------------------------------------- ._Phone Address ------ ---2/_ 7-----�- r ` --------------- --- ------------ City - --------------------------------------------•-------•-•-•-- Contractor's Name ---------- ---- ---------------License # &'p/.- '- --- Phone Installation will serve: Residence Apart ent House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other -------------------------------------------- Number of living units:...!-_----- Number of be ooms -__'_____Garbage Grinder Lot 5ize�QQ_�X'l �kl.Sf�l�_ 6� Water Supply: Public System and name ______ _/ G _.. -----------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ED 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,) PACKAGE TREATMENT { ] SEPTIC TANKSize _ _ _�____--______ Liquid Depth ____ ___�___.___..__. Capacity, .Q�6i44_Type � _ ___ Material__ c1 No. Compartments ... ............... - Distance to nearest: Well -----�i�-----------__________Foundation _._,-0-__!------: Prop. Line ------S7----_________ LEACHING LINE X No. of Lines _____�_____________ Length of each line/0�--------------- Total Length __ , �__..__::.. 'D' Box __ Type Filter Material _1P ____Depth Filter Material ---`5�1_--_(___________________________ Distance to nearest: Well _4vv--- Foundation ----Zd- P --------- -- Property Line -4—...-•-------:.. SEEPAGE PIT Depth _nb7-Vie----- Diameter Number ------C;7 Rock Filled Yes * No I] Water Table Depth -----------5;a, ------------------------------Rock Size t ------------------------ \ Distance to nearest: Well _______ _10___________________ _Foundation __ Prop. Line __ ___..___..____. r , --------- �n3 REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------ ___ _____ Date ________-_____'-`__ _ ______ r Septic Tank (Specify Requirements) -------------------------------------------------------------- I----------------------------------------------•----------------------------- *0\ Disposal Field (Specify Requirements) ---------- -------------------------------------- ------------------------------------- lk ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -.-.. . (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. Homeowner 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 become subject to Workman's Compensation laws of California." `,: ' Signed . -- Owner r 1 -------------------------------- -------------------------------------- ---- BY Title ---- ---- -- --------- ----------- -- --- ----------- - - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -- - - ------------------ -- - - - DATE ----------- BUILDING PERMIT ISSUED ------------ -------.DATE -------------•---------------------- ADDITIONAL COMMENTS ---------------------------- ------------- -------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- �. -------------------------------- ---------------------------------------- -- --- ---------- ---------- - ------ - -------- - -- - - - - -------------------- -/� Final Inspection by: --�� ------------ ----- --- ---------------------------------------- Date :/. ---�-�---� 'f'---------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-;08 Rev. 5M a