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4* JFaR OFFICE USE: ti^ � �_ APPLICATION FOR SANITATION PERMIT • Permit 1 'j(j _ (Complete in Triplicate) ---- -----•----F ---- - --------------- c - �, ' c ;, Date Issued .a,_. . ____ _________________________ This Permit Expires 1 Year From Date Issued _S1 pplication is hereby made to the San Joaquin Local Health District for a per 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/LOCATION ------------- -��---------��.---------,_. - 4! ----------CENSUS TRA T _________._._____------ •-��=-_------ . Owner's Name.�'; � ��-- ------- _ ---:.--Phone _ Address �-----------------------------•------------------------------------------------• City ----`-��r------------------------- ------------------ Contractor's Name --- /C�`'- ------r ', '-------s -----------------License _-- Phone Installation will serve: Residence [Apartment House❑ Commercial :❑Trailer Court ❑ Motel ❑Other --------------------------------------------- f Number of living units:-_--_--_. Number of bedrooms _______Garbage Grinder ___ Lot Size ............ Water Supply: Public System and name ------------------- --------------------•------------------------------------------Private ❑ Character of soil to a depth of 3 feet: SandE] Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe ip?r 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: fNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) O PACKAGE TREATMENT SEPTIC TANK Size___ - l �-.��---�.1��---- --------- Liquid Depth -r---------------- Capacity Type� SMaterial ___ Flo. Compartments Distance to nearest: Well -.__"___________________________Foundation -----e-47- -------- Prop. Line ---____-------- LEACHING LINE No, of Lines -----/_________________ Length of each line---/Qa--------------- Total Length _10-0 r. D' Box Type Filter Material _ale.- __Depth Filter Material __r__ ____________________________________ Distance to nearest: Well ---------- Foundation O_0 ------ Property Line SEEPAGE PIT Depth ::'. __ Diameter _ `__ Number _____I___________ _ ":-_hoc ed Yes„ No 0 Water Table Depth ____� P________________________ _ Rock Size _-,.� \\�� Distance to nearest: Well _.�"'_ ______________________Foundatio __._________________ Prop. Line ____ __._____.___.. F ,.k REPAIR ADDITION( rev..'Sanitation Permit# ____________________________________________ Date __________________________________) SepticTan pecify Requirements) ------------------------------------------------------------------------------------------------------------_----------------------------- Disposal Field (Specify Requirements) ______________ _________-______.__----________- ---- ----------- -- --- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- --- ------- ----------------------------------------------------------------------------------------------------------------------------------------- (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 Joaquin Local Health District. Home owner or liven- 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 Workman's Compensation laws of California." Signed Owner = ------ ---- - -- By ----------------------- , : - -----t-------- =" .Title ` ' jf � - {lf q r than o 1k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ____. DATE _.6__ '}3---------------- - -------- ---------------------------------------------------------- BUILDING PERMIT ISSUED --- - ---=--------------DATE -------------•------------ ---------------- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------------------------------------------------------- - --------------------------- ------ --------------- ----- FinalInspection by: ---------------------------------------------------------------------------------------------------------.Date .... SAN JOAQUIN LOCAL HEALTH DISTRICT i y � E. H. 9 1-'68 Rev. 5M