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FOR-OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- (Complete in Triplicate) Permit No. ___________________ This Permit Expires 1 Year From Date Issued bate Issued/ fir_ ----- r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work'herein 1 described. This application is made in compliance with County r ina ce No. 549 and existing Rules and Regulations: JOB u µ K • DRE�LOCATION Owner'sName _ \ --.l� } _CENSUS T RACT ------------ -•---------`- - � ne tYAddress r _ s Contractor' Name _._______-- _ _ _.License # _ /1----- phone�f ,.tons - Installation will serve: Residence ❑Apartment- use.❑_Commercial:❑Trailer Court 0 Motel ❑Other _ �� xa Number of living units:_ _________ Number of bedrooms�____________Garbage Grinder _.---------- Lot Size ----- -_ ater Supply: Public System and name ______________________________________ ------.-------_Private x ---- Character of soil to a depth of 3 feet: Sand' Silt Cla ❑ ❑ y ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ )Adobe-❑ Fill Material -_-._._____ If yes, type ---------------------------- '(Plot ___________________ - h '(Plot plan, showing size of lot, location of system n relation to- wells, buildings, etc. must be placed on reverse side.) i NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,} s PACKAGE TREATMENT ` ' [ ] SEPTIC TANK S�ie_______ liquid Depth ____� ------ ��. - r ----------- Capacity �. Capacity ( - ------ 'type __'__ __ Material--- N o, Compartments f: r bistance to; nearest: Well__ -------- �56---------------Foundation __/_0--------------- Prop. Line ---- LEACHING --00 LEACHING LINE No. of Lines _____��_ -- -_ - Length of eac line__ _c�- - ---____-_ Tatal Len th .. g -�iL¢ 'D' -Box ✓lType,Filter.Material, __-_ _ _ ._____Depth Filter Material _ .4 4CM // Distance to neaPest: We[ f ---------- Foundation ---/f3------------- Property Line. ---�--------•---- SEEPAGE PIT [ ] Depth -----------1 --_--- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No ❑ Water Table . pth --------- ----------------•---------------------Rock Size ---- Distance to nearest: Well _________________ --- _____ --------------------_________-----_Foundation ___ ____.____-_____ Prop. Line _______.__ ----------- REPAIR/ADDITION[Prev. Sanitation Permit# -------------------------------------------- Date Septic Tank (Specify Requir m�ents)j_____._____- Disposal Field {Specify Requirene ts) _________________ ___ ------------------------------------------------------------ - -------------------------------------------------------- {Draw existing and requied 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, Slate Laws,Eand,Rules and Regulations o-f the-San Joaquin Local Health District. Home owner or licen- sed agenks signature certifies the following: ` "I certify that in the performance of thework,.fpr—Which this permit i;..issued, l shall noe„employ .any- person-In such manner:_._,;, as to'become subject to Workman s Compensation law of Californio.'._ Signed ----------------------- ----- Owner CL BY J ------------------------- - Title �. other n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED"'BY"._'� -- - --- - r - - DATE - /-lS�_ j------------- BUILDING PERMIT ISSUED ------------ - { = F ° ---- -----------------=--------------DATE ------------- --------------- ------------- ADD1TiONAL COMMENTS _______________ l. ------ ----- --------- _---_r-_ s - --------- ---Y ----- ------------------------------------ --- _ _.._ --------------------------------------------------------------------------------------------------------------------------------------- ---------------- --------------------------------------- --- . --------- - = Final Ins ection b _ ------- --- p Y -------=--------- -------------------------------Date Yy'�r ` } ,1t s r� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM -:s