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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ---------------- ---------------------------- (Complete in Trip nate ---------=------------------------------- ------ - 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: l ---------------CENSUS TRACT ------- ----- JOB ADDRESS/LOCA ON --- Owner's Name �� Phone ------------ --- I / ; © ---------C --------------------------------------------- Address - �f-- -C ------ City - - `e', - - Con#ractor's Name -----License # 1 ---- Phone ----------------------•-----•- Installation will serve: Residence eApartment House 0 Commercial []Trailer Court ❑ Motel ❑Other ------------------------------------------- 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. Sand'❑ Silt❑ Clay F] Peat El 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.) v NEW INSTALLATION: (No septic tank or seepage permitted if public.sewer is available within 200 feet,) H PACKAGE TREATMENT [ ] SEPTIC TANK' . Size __-- �r----x-��-;- Liquid Depth ----:-'�`/-+-,----- /� v -- Material-�-�7 No. Compartments Capacity/�/�' -�- TYp � ----=-�---- / -------------Foundation -- Prop. Line --- ------ �j Distance to n arest: Well LEACHING / LEACHING LINE [� No. of Lines ----- ---- Length of each line---- --- ------ Total Length ,j '; !---------- 'D' Box -----/---- Type Filter Material ------ r :----Depth Filter Materia -----------------------------...... Distance to nearest: Well ______ ____-- Foundation ____�� _____ Properfiy Line __ 1 ---.---•.•-•, SEEPAGE PIT [� Depth 7-- -- .5 Diameter �____ --________ Rock Filled Yes No .0 fi�rr-�- --- Number --�-�-----� � Water Table Depth ---------------L�-O- Rock Size /� ----•------ Distance to nearest: Well ---------I0E? --------------Foundation -J_V_ -------- Prop. Line __ _------------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) - ------------------------ ----------------------------------------------------------------------------------------.. Disposal Field (Specify Requirements) ---------__ --------------------------------• " ----------- - -----------------------------------------------------------(-Draw ---------Draw-- existing and required ad dition on reverse side} i 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 orlicen- 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 War n's Compensation laws of California." Signed ------ ---------------------- ` -- - ' --•- Owner </ Title✓`� /.`' " ---------------------- (If other than owner) FF I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- - ----- -- - --- - -- -----------. DATE _ —- -- --------------------------------- -- -------- ----------------------------------------------- BUILDING PERMIT ISSUED -------------------------------- -- ----------------------- --------------DATE _.---------------------------------=------- ADDITIONAL COMMENTS ----------------- --------------------------------------------------------------•- . ------------- ---------------------------- ------------------------------------------------------------•------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- or --------------------- ----- ------------------------------------------ --------------------- - - _ _ Date ---� --------------- ------------- - ------------- Final Inspection by ----- -------------- -- ---- - =--------------------------------- - - - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.