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/ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------€i------------------------------ ------ Permit No. !i (Complete in Triplicate) --------- ---------- -------- ---------- _------ €� --"--- This Permit Expires 1 Year From Date Issued Date Issued -------------- -3 6-Se 2- Application 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 Ryles and Regulations. ,,77 S - - - -- --- _ -----�- - -------------f1!�CENSUS TRACT Owner's Name -- --------------- =- Phone ------------------------------------ I � - , Address -----.. --- ----- ��7--------- ----- ---------- !��-��---------------------------- a Contractor's Name ---------- ,/Jh1tt.�.�t� d.License # "" -- Phone ______________________________ Installation will serve: Residence ❑A artment/House Commercia :❑Trailer Court ',❑ Motel ❑Other .... J --- -------------- - Number of living units_____________ Number of bedrooms ____________Garbage Grinder ------------- Lot Size ._________________________________ ...... i Water Supply: Public System and name ------------------- __ ____________________Private ❑ Character of soil to a depth of 3 feet: Sand'E] Silt.❑ Clay ❑ Peat❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK'[_] Size------------------------------------------------ Liquid Depth ---------------------..1 f1 i apacity -------------- --- Type -------------------- Material--- ------ No. Compartments -----------------= i i ---- Prop. Line ----------------- i [ � Distance to nearest: Well ------------------------------------Foundation _____.____________ ..... LEACHING LINE No. of Lines . � ------- ------ ---- -f- Length of each line - - -- Total Length ----------------........_ .. I I 'D' Box ----------.- Type Filter Material --------------------Depth Filter Material -------------------------------- _"1 Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ________._______...:.__� ' SEEPAGE PIT [ ] " Depth ---_----------_------ Diameter -------._.--------Number ____________________________ Rock Filled Yes ❑ No Water �! onea Table r Distance est: Well-------------------------------------------Foundation -------------------- Prop. Line ---------------------- € REPAIR/ADDITION{Prev. Sanitation Permit# --------------------------------------------- Date _____________._....___.__.._ -----) I'Septic Tank (Specify Requirements) -- :.: - ----------------------------- ---- --•- 1 ---- ,�I Disposal Field ( pecify .Requirements) --_!-1_r Q�__ .__ ------ --------------I-------------------- ------ i - t �T -- gj-------fie..' I j :'l - (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin I County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- i. sed agents signature certifies the following: "Ik 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." r €� ;. Signed ---------------------------------------- ------ Owner ----------- i. BY ------------------------------------------------ --- ,�± ' Title (If other than owner) n FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- . ----------------- DATE.1_'_3_�__�?- _-----.-.-___-,. <<' f -------------- - - BUILDING PERMIT ISSUED'------ ----- --------------------=--------------DATE ------------------------------------------- ADDITIONALCOMMENTS-------------------------------- ----- ----------------------------------------------------------------------------=--------------------------- -------------------------------------------------- ------ -- - ------------------------------------ -------- -- --------------------------------------------------- -------------------------- -------------------------------------------- - ---- - ---- --------------- ------. -- --- --- - - ------- ----- Filial Inspection by � ------------------------------------------------------------------------Date Q ------------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT P E. W-9 1-'68 Rev. 5M:.