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Y ' FOR OFFICE USE: . R r APPLICATION FOR SANITATION PERMIT --------------- ---=-- ----- ` (Complete in Triplicate) Permit No_ ____ ' ----------- --- ---------------------------- - af Thrs Permit Expires 1 Year From bate Issued Date issued __ '_ _-� e r 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/LOCATE N --------- : - ---------a ._..__.__CENSUS TRACT _ Owner's Name - - ------- µ hone Address -- /----- --- Cit � y - ---- ---- --------- ---- - -••------ E Contractor's Name ._ -- ------ ---------------- ----------- -----;------------------- -----------License # �i Phone_ -Ao- Installation will serve: Residence partme'nt House❑ Commercial []Trailer Court ❑ !Motel El Other ----------------------------------- - Number of living units..---------- Number of be s ______ arbQge Gri d�rt!tiv__.___ Lot Size _- __ (( Water,Supply: Public System and name �____--_-___ ----------------------- -- ---------------•---------Private [] 4 Character of soil to a depth of 3 feet: s Sand'❑ Silt❑ Clay C] Peat❑ Sandy Loam ❑ Clay Loam;❑ i, HFa,rdpan [f Adobe Fill Materiae_-___ 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 TANK:[ j Size------------------------------------------------ Liquid Depth ----------------_•--,_-_-- Capacity ------ Typey Material------------------ --- No. Compartments ------ -------------- fDistance,to nearest: Well'____�---------------------•---------Foundation ---------------------- Prop. Line ----------. --:-_-.._-- LEACHING LINE [ ] No. of Li#es _____ _______________ Length of each line-._______-.--_-.-----.-._:;:Total Length � fl 1 n� 9 V ' D' Box _. __. . Type Filter Material ----------------- -Depth Filter Material -------------------- F� - t �;. Distance to nearest: Well ______________________ Foundation ------------------ ----- Property Line ---------- __ SEEPAGE PIT' [ ] Depth -., --- ----- .1-_ Diameter' -- ------ Number --------------------------- b :I �.t , Rock Filled Yes [] No i0 p Water Table Depth`------------------------------------------------Rock Size -------------------------------- r - �, Distance to.nearest: Well _------- _____________________________Foundation -___-..---___-__--__ Prop. Line _--_--- _ I REPAIR./ADDITION(Prev. Sanitation' Permit#'-------- ------ Date ----------------------------------) r Septic Tank (Specify Requirements) %---------------------- ---- ' x n t Dis. asal/Field (Specify equiremehts) _ i 1 , --------------------- -------- ------ ---------------- - --------------------------------------.--------------------------------- ----- ----- � ; (Drawexisting and required addition on reverse sside) .. ;- I hereby certify,that.I have prepared,,this application and,th-&t the work will be done in accordance with San Joaquin County Ordinirnces,.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 irithe performance of the work fwhich-this permit is issued, I shall not employ any person in such manner i as to become subject to Workman's Compensation,laws of;California." Signed -. = W Own er_ � e� ---------------------------------------- - - BY _ : --------1 - ------ Title - - --- - _ ._ .. ------ -------------- --------------------- (I o r than owner} - t r EPAitTMENT USE ONLY r APPLICATION ACCEPTED BY .-------- -__. DATE,,- �'_ - ° BUILDING PERMIT ISSUED ----------- _ --------------------------------------------------------------DATE ----_---._._-• ADDITIONAL COMMENTS ---------- - - - --- --- ---- ---- ----------------------- - -- ------ -------------------------------------------------------------- ---------------- ' ----- -- ------------- ---------- - ----------------------------- ------------------------------------- ------------------------------------- Final Inspection y: ----__Date - AN 'JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Re . M