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FOR OFFICE USE: ,o ------------- -------------- ----- APPLICATION FOR SANITATION PERMIT r (Complete in Triplicate) Permit No. -----------a ------ i------- TThis Permit Expires ] Year From Date issued Date Issued __40_-01 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: JOB ADDRESS/COC ON C. l SS �� _ - ---CENSUS TRACT --------------- °Owner's Name ------------------ ------- -------Phone ----•- L. Address __sZ wCit Y -------••----- Contractor's Name - �� -.License-#44M Phone Installation will serve: Residence �partment Nouse❑ Commercial ❑Trailer Court !,❑ ) MotelOther•_- ---------------- Number ------- ---Number of living units:.____j____- Number of bedrooms __3-------Garbage Grinder - _-_-___ Lot Size Water Supply: Public System and name Private [�~ - - - ------------- Character of soll to a depth of 3 feet: Sand❑ Silt❑ Clay El 'Peat❑ Sandy Loam ( lay Loam.[] i f Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type --------------- ------------- (Plot -__-.-___--_._____._ __(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must belaced on reverse side. i`. p ) NEW INSTALLATION: [No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK'[ ] ✓ Size------------------------------------------------ Liquid Depth --------------------------- Capacity ---------------------Capacity --------- ---------- Type.------- ----------- Material_ No. Compartments (� i------------------------------Foundation ---------- �} ---------------- LEACHING LINT: Notance to nearest: Well ____.___ Prop. Line ______________________ J ---:----- ---_. r is of Lines ngth of each line---------------------------- Total Length 'D''Box ------------ Type Filter Material --------------------Depth Filter Material Distance to nearest: Well ------------------------ Foundation ------------- ---------- Property Line -------------------- - SEEPAGE PIT f ] Depth ------------ ------ Diameter - - ----------- Number -------------- ------------- Rock Filled Yes ❑ No �£. Water Table Depth ------------------------------------------------Rock Size i _ Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------------- --------- REPA[i/ADDITION[Prev. Sanitation Permit# -------------------------------------------- Date -----,-----------_ -- ------__-_-) i Septic•Tank (Specify Requirements)______________________ Dispo I Field (Specify Requirements) ---------------- - ------------------------ l- �-o--- (J •�'b � -- ------------------------------------------------------ -- [Draw existin and required addition 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 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 s ct to Workman's Compensation laws of California." Signed ---- -- Owner _ -- --- ---- �----/--�------------------------------ By ----------- = `.4 Title T d (if other than owner) - ----- ----------------------------- f .. FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY , DATE J BUILDING PERMIT ISSUED ------------------------ - ------------------- ADDITIONAL COMMENTS .__ DATE . --------------------------------------=----------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- ------------------------------------------------------ ----------------------------------------------------------------------------------------------------- - - - - ----- ---- ------------ - - Fina! Inspection by: ___________ -Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M