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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ......... ........................................••--- (Complete in Triplicate) _ .............................................. Date Issued _-......... ............. .... This Permit Expires 1 Year From bate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein t described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations- mit I _ - -.-_--_-__....... JOB ADD -� � �-�- -•..-•--•- CENSUS TRACE Owner's Name .................................._-••----- ......:.. Phone Address _....__I .'T. . . .... . City �-. .............................. p..._ _AF�. *. hone Contractor's Name .... 1� ir. . ....... ...................... License # ._ ...._. installation will serve: Residence ❑Apartment House] Commercial ❑Trailer Court Motel ❑Other .f........K. :..........••-- i Number of living units:......1... Number of bedrooms .__.! __--Garbage Grinder .._. ------- Lot Size .......................... Water Supply: Public System and name ................ Private ; I` Character of soil to a depth of 3 feet: Sand . Silt ElPeat Clay ❑ ❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe.❑ Fill Material ............ If yes,type (Plot plan, showing size of lot, location. of. system in relation tor 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 [ I SEPTIC TANK f ] Size...........................•......• ••.._... Liquid Depth ......._. ................ 04 -- Material...................... No. Compartments ...................... W ; Capacity ..................... Type ....---•---- W . 'y Distance to nearest: Well .....................................Foundation ...................... Prop. Line .... LEACHING LINK No. of Lines ---.... Length of each line............................ Total Length ...----•---......_........-. [ ] -- 'D' Box Type Filter Material ....Depth Filter Material .......................---------------.•:... d Distance to nearest: Well ........................ Foundation Property Line .....................tXF SEEPAGE PIT ( ] Depth Diameter. ................ Number .---_------........_........ Rock Filled Yes ❑ No (3 Water. Table Depth} Rock Size ....................•---........ .p Distance to nearest: Well.........................................Foundation Prop. kine y. REPAIR/ADDITION(Prev. Sanitation Permit ........ ....------------------••............ Date ................................... 1 Septic Tank (Specify Requirements) ............... ............. ®_ = .......------.x_.,-..................................•----...._....-.......-•--------•.._..... Disposal Field (Specify Requirements) ` ` f •-• -.....--- •••----1-�� -"-'•--• - ----------•-- ----- (Draw existing and required addition on reverse sideI I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin I County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or licen-sed agents signature certifies the following: k 4 "I certify that in the performance of the work for which this permit is issued, t shat) not employ any person in such manner as to become subject to Workman's Compensation Iaws of California." Signed - . -----.:...... - .. Owner (If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... . ....... .. .. . .. .C_.._....._..._..._......__...----. ............................ DATE ..�.�.-.. __7 • BUILDINGPERMIT ISSUED _----•• _ •-----------------------•- --•-••------.........----•-........------........--•-- ........_DATE ............................... ... ---• ADDITIONAL COMMENTS ............................................ - _......---•---•--------------......................................I.............. .......I..............•- �....... .._ ...... ...------ i ----------------------------------.... __ 5........... ...... Final Inspection by, _. ...�..f�•? �''-'�-•--•---•------------ ......................... ....---• Date .f..�. SAN JOAQUIN LOCAL' HEALTH DISTRICT 7/72 3 M