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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: (complete in Triplicate) --! -------------- ---------------- ---------------- - Date Issued This Permit Expires 1 Year From 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 compli nce wit County Ordinance No. 549 and existing Rules and Regulations! �] � - ---------CENSUS TR CT - ----------- ----------- JOB ADDRESS/LOCATION .--- f7`/-� - - � / D _ {/ �� ------------ Phone - - ,1 ��-- Owner's Name �_ . _ f --- --------------------------------------- -- - - - --------- --- c I`?rcw/�----------------------------------------------- Address __A-Ifl City Phone _ Contractor's Name -.-- _- - --- �- /-�9� ------------- - �7 ��' License # - ! Installation will serve: Residence [RApartment House'❑ Commercial .❑Trailer Court ,❑ Motel ❑Other ---- ------------- ------------------------- , Number of living units:----1`---_ Number of bedrooms _ __ ___Garbage Grinder ------------ Lot Size _------------------------------- Water Supply: Public System and name --_____---------- - -- - --------------------- -----------------------------------------Private Character of soil to a depth of 3 feet: Sand jSj- Silt❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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 [ I SEPTIC TANK [ ] Size____ . ~- �� Liquid Depth -- -- E_ _ atena!_�—� -- - -- - o. Compartments ---------- Capacity f_�.-_��Q---- Type ��--�- --- r - -- - - � i Distance to nearest: Well ------- �C --------------------Foundation _ ---------- Prop. Line ----------------- LEACHING LINE [ I No. of lines ------------------------- Length of each line---------------------------- Total Length ----------- 'D' Box .----------- Type Filter Material --------------------Depth Filter Material ---------------------------------------•---. Distance to nearest: Well -------------------- Foundation _--- ------------------- Property Line _------------.-.-------- SEEPAGE PIT :[ ] Depth Diameter ---------------- Number --------------------- ------ Rock Filled Yes ❑ No �❑t/� WaterTable Depth ------------------------------------ -----------Rock Size ---------------------- --------- Distance to nearest: Well --------------------------------- ------Foundation ------ Prop. Line ...........-------- -. REPAIR/ADDITION(Prev. Sanitation Permit# .........------------------------ ---------- Date ------------------ ---------------) Septic Tank (Specify Requirements) ---------------- ------------------------------r--------------—------- - -- - ----- - ----------------------- Disposal Field (Specify Requirements) - -----------------------------I-----------------------= ------------------------ -10 ------------------------------------ -------- ---- - - - ---------- ----- P (Draw existing and required addition on reverse s e) I hereby certify p that I have prepared this application lication 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. 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 become subject to Work anis Compensation laws of California." Signed Owner BY ..... � r By (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ' —----------------- DATE -----�-'�---�---------------- BUILDING PERMIT ISSUED ------------------ ---------------------------------------------------------------- ---------DATE - ----. ----- -----•- --=------- ---------- ADDITIONALCOMMENTS --------------------------------- -------------------- ----------------------- ----------- ----------------------------------- ------------------------------------------------------------------------ ---------------- ---------------- --------------------- ------- Date Final Inspection b ---- ---- ----- ---------- SAN f� � 3 JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M