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FOR OFFICE USE: ; :APPLICATION,FOR SANITATION PERMIT {Complete in Triplicate} Permit No. --- --------------------------------------------------- This Permit Expires 1 Year From Date Issued Date IssuedD__ __ 6 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 witLh�ounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT ON .__--_ _� _g-_e---- e ------------------------------ -----:-.- CENSUS TRACT Owner's Name 131 '- "� = --------Phone ---------------- Address ---7;Z2___-1_ �_--_ -------------------------------- City Contractor's Name ---_ S _-____.License # f7.�� ----- ---------- �---------- ----------- ------------- --- =- ----- Phone ------ Installation:wili serve: Residence [�-Apartment House-[] Commercial❑ ------ Trailer Court ❑ Motel ❑Other Number of living units:_.__------ Number of bedrooms ---/-------Garbage Grinder - ___-- Lot Size • ---•-•------ Water Supply: Public System and name ---------- - /------------------------------------ --- ---------------- - ------------- -- _ Private E]Character of soil to a depth of;3 feet: Sand ❑ Silt❑ Clay E] Peat❑ Sandy Loam E-] Clay-Loam Hardpan ❑ Adobe Fill Material ------ If yes, type -___._-_____--________ (Prot 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 Liquid Depth ._______ [ ] Size------------------------------------------------ Capacity I------------- --JT ---------- ----- Material---------------------- No. Compartments ------------------ Distance to nearest: Well ------------------------------------Foundation ---•------------------ Prop. Line ---•-•---------------- LEACHING LINE [ ) No. of Lines ------------------------ Length of each line----------------------_---- Total Length 'D' Box ___ ------- Type Filter Material ____________________Depth Filter Material _.--________ ---------- Distance to nearest: Well ------------------------ Foundation --- ------------ --- Property dine •�, SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes .0 No i❑ Water Table Depth ------------------------------------------------Rock Size -------------___--- Distance to Inearest: Well -----------------------------------,----Foundation ---------------,---- Prop. Line -------____-------•_-- REPAIR/ADDITION(Prev. Sanitation.Permit# -------------------------------------------- Date ----_----------_-_--- _ Septic Tank (Specify Requirements} ---____-------___--------------- - ------------------------------------------------ - - - Disposal Field (Specify RequiremIents) ____-__�_`_"_1_�______ ( - -------------- --------•----------- --------------------------------------------------- ----- --- --- ' ----------------- ---------------------------------------------------- -- - -- ---- - - (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 licen- sed agents signature certifies the following: "I certify thatin, hemperformance=oft e-wark=for-which4his4p_ermit is issued, I shall not employ any person in such manner as to becomes� ' to Work omp ation laws of Califor p lei Signed ------- ---- Owner ------ --- ----- - ---------- ----------- - - - - - ---- Title -------- - - (If other than owner) fi FOR DEP TME T US ONLY APPLICATION ACCEPTED BY -----------{--------------------- BU ------- -------------- -------- DATE ---- -- 2- --_�_�__.l ILDING PERMIT ISSUED -- --= EATE ADDITIONAL COMMENTS ----------------}------------------_-- _ -- - ------- ------------------• -- - -------------------------- -------------------------- -------------------- -------------------------------------------- -------------------------------------- --- - --------- ----- ------------------------------------------ --- --------- ---------------------------------------------------------- }------------------------------------------- Final Inspection b is --- ------------- �l p Y - ---- --------- -'- ------------.Date ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M,