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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �. A Permit No. .. --------------------------------------- - (Complete in Triplicate) ------------- --------------------------- IQ -- __.___- --------- ------------� __ _--_- 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 gmpliance with County Ordinance No 549 and existing Rules and'Regulations: JOB ADDRESS/LOCATION . '--:-- _ ---------------------CENSUS TRACT _ ..--- ----- ---------- Owner's Na - - ------ -------------------�------------- - - ---------------- `- Phone � .y ............... f' Address ----- -- - .__. Cit ------ -------- ------------------------------------------------ Contractor's ----- ------------------------------Contrac#or's Name --------------------------------------- - ---- - ------------------------ �`'`License # ------------------------ Phone ------- --------- ......... Installation will serve: Residence ❑ Apartme "o s_ Commercial : Trailer Court ',❑ Motel ❑Othe ___-. •- -vim__ _- �, Number of living units------------- Number.of bedrooms --------Garbage Grinder __.------- - Lot Size ----------------------.---_-_--__-_------_ Water Supply: Public System and name ----------------------------------------------------------------- ----------------------------------Private ❑ Character of soil to a depth of-3 feet: Sand'[:] Silt Gay ❑ Peat-E] Sandy Loam lay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- r` i [ -1 (Plot,plan, showing size'of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) -j' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 1„, PACKAGE TREATMENT [ ] SEPTIC TANK[ ] """ Size------------------------------------------------ Liquid Depth ---------------__ , Capacity ' Ca ,. p Y --- ---------------- Type -- ----- • - -- Material-------------------+-- No. Compartmenfis _ :�+ Distance to nearest: Well ____________________________________Foundation ---------------------- prop. Line ---------------_-_-^ "� .[ V9 j LEACHING LINE ( ] No. of Lines --------------------- Length of each line.______________ --_____-__-- Total Length _ y ----------- ------------ 'D' Box ------------ Type Filter Material -------------------Depth Filter Material ------------------------------.---.------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line -------------------___.7Z SEEPAGE PIT [ ] Depth ___________________ Diameter ---------------- Number --------------------------- Rock Filled Yes [3 No i[] k. Water Table Depth ------------------------------------------------Rock Size -------------------------- ; Distance to nearest: Well ----------------------------------------Foundation ...------._._.------ Prop. Line -------------------..tet i REPAIR/ADDITION(Prev. Sanitation Permit# --- ----------------------------------- -Date ------:---------------------------} (J'� Septic Tank (Specify Requirements) -------- ----------- --- -------------- Disposal ------------Disposal Field (Specify Requirements) ---------- - - ----------- - -- _ - ----- ------- - --__------------------------------ I ------- ----- - . - _ cfi - ---- ------------------------------------------- -- ---- ------------_------------------------------ �..._ .- (Draw existing and required addition on reverse side[ I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin 1I 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 person in such manner as to o�btoman's Compensation laws of California.Signed Owner BY --------- --------------------------------------------- - ---------------------- --------------------- Title --- ------ ------------------- ; (If other than owner), FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' ----------------------------------=------------------------ DATE ----- ----'�-�----- -3------- BUILDING :PERMIT ISSUED. ------------- ------ -----_ - ----- ADDITION./AL COMMENTS --- - DATE..----- = ----------------•------ __ _._._____ _________ ------- ________ ------------------ ------------ -------- -_ ____ ------------------------------------ _ --------------------------I---_ _--. --- ----- -__----------------------------- ---------------- ---------------------------- - - x Final Ins ection b _---_----. Date .. . _f . ` P Y- --- -- - -- ------ ---- --------------- - SAN J.OAQ.I IN '1OCAL HEALTH -DISTRICT E. H. 9 1-'68 Rev. SM r ` - f�,r ti