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FOR OFFICE USE: i 6—1 -- _ _4 ,�a APPLICATION FOR SANITATION PERMIT y - (Complete in Triplicate) Permit No: t ----- --------------------------------------- -------------- ------ This Permit Expires i Year From Date Issued Date Issued 4�--=1�__-- � Application is hereby made to tt_e_- n* quin Local Health District fora permit to construct and install the work herein described. This application •s made in com littn a with County Ordin ce o. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI _ —lam CENSUS TRACT - Owner's Name _ -------------------Phone Address -------------------------- Cit Contractor's Name .-- O- Pho e - � { _ -.License # Oc2 //_ `` Installation will serve. Residence Apartment House,❑ Commercial❑Trailer Court Motel ❑Other ----------------- -------------- Number of living units------ Number of bedrooms __-7�Garbage Grinder -.---------- Lot Size ----7 _ _ ------------ Water Supply: Public System and name _---__---------------------- �I ` -------------------------------------- -------------- Private --------------- - - Character of soil to a depth of 3 feet: Sand�❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe .Fill Material ------------ If yes, type -------------- (Plot plan, showing size of lot, Iocation of system in relation to wells, buildings, etc. must be placed on reverse side:) NEW INSTALLATION: (No septic tank or s'eepage$it permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size----------------------------------- ------------ Liquid Depth - ---------------- T`Ca act ---___-- -------------------- aera -------------- ------- No. Compartments ------ ------- Dis#64ce Ito nearest: Well ------------------------------------Foundation ---------------- ---- Prop. Line --------------....._-- ' LEACHING LINENo. -, I �1 i" [ ] of Lines -------------- - ----- Length of each line--------------------------- Total Length 'D'. Box f' f i''ype Filter Materia) -------------------Depth Filter Material Distance to nearest: Well------------------------- Foundation ----------------------- Property Line SEEPAGE PIT 1C j Depth ---- ---------------, Diame#er -_-_--_---_ I - Number -_------------------------ Rock Filled Yes ❑ No .i❑ '- Water Table.-Depth '_---_____ - _ .____�__ ,------Rock ----- -- Distance to nearest-!Well ----}--------- ----------t!- ---'------Foundation -------------------- Prop. Line ------- I i ri ti.i i�w. � - - i REPAIR/ADDITION(Prev. Sanitation Permit #----_-,-- - - - = ---_-?_-- D ----------•------------------) -------- Septic Tank (Specify Requirements) ------------------------------- Disposal Field {S ecify Requirements) �_ _-- ___- Q�q _ --f ' .. - __ c . � . t {Draw existing and required 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, State Laws, and Rules and Regulations of the San Joaqu n Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in th erformance of the work for which this permit is issued, I shall not employ any person in such manner as to become je to Workman's Compensation laws of California." Signed -------- •_.- - - - - — �._._ --- --- --------- ----- -. - ---- --------- --------------- �--�- Owner By ----------- ----------- ----------- --- ----- Title -- ------- ' { (if other t caner) ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___ � _ 4 -.--_____. DATE _.-_ - -�7_ ------------- BUILDING PERMIT ISSUED -------------�_-__-- -- DATE -------------------- ------------------------------------------------------------------- ----------------------- NAL COMMENTS -------- ----------- - --- - - _ -------------- ------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------ a_ ;ei- ---i--- __ _ ___:-- _.__:_-_,:----_ ----=-----------------:-.------------------------------------ - -------------------------- - -----dr - --- Final Inspection by: -- - i --Date -- - --- l--�._-------- = ------- --------- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M