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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 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 ..---`14—, 1------------CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION N . 1� ------ Owner's Name ---------- -•-------------------------- Phone S Address `' .: - - ----- - -- - --------__ City --- ------------------------------------------------ -� Contractor's Name1x-� - ---- License #� � Phone Installation will serve:- -- -i.—Residence Apartment House,❑-Commercial �STrailer-Court• Q Y - - Motel ❑Other -------------------------------------------- Number of living units:------t____ Number of bedrooms 3-------Garbage Grinder ------------- Lot Size ____ ------- Water Supply: Public System and name -------------------------------- ------------------------------- ------Private Character of soil to a depth of 3 feet: -Sand'❑ Silt❑ Clay .❑ Peat❑ Sandy Loam Clay Loam Hardpan ❑ . Adobe ❑ Fill Material ------------ If yes, type ---------------------------- c. (Piot 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,) / `i PACKAGE TREATMENT { ] SEPTICTANK Size G___�I'9____�'s---------------- Liquid Depth __4V__-__-_--_-.-------- CU Capacity ,Z-�a__ , Type 'MaterialG�'J N_a.r Compartments ------ .......... I Distance to neare Well ------------------------------------Foundation ---- ------------- Prop. Line ---------------------- LEACHING LINE [ No, of Lines __. _____________ Length of each line----____0_ --- ------ Total Length ----------- .___. q D' Box .tnearest: Type Filter Material ____ 1 __-__Depth Filter Material ----1-�-_________________I--------- .__.. Distance Well -----Jo__I___________ Foundation ----IV--------------- Property Line _____-_-_-- � SEEPAGE PIT [ Depth ---_--------------- Diameter ---------------- Number -------1------------------- Rock Filled Yes ❑ No WaterTable Depth -- ------------ ------------------------- ------Rock Size -------- --------------------- Distance to nearest: Well ---------------------------------------=Foundation ------------------- Prop. Line ------------- ........ s REPAIRJADDITION(Prev. Sanitation Permit# -------------------------------------------.- Date --- ---.-"----------------------} Septic Tank (Specify, 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 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 subject to Workman's Compensation laws of California." Signed --------------------- ': Owner_ "` BY JV/ Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------- DATE,C'_,3/�- ------------------ ,BUILDING PERMIT ISSUED --- ---------------------------------------- ------- -----------------------------------------------------DATE ------------------------------------------- ! ADDITIONAL COMMENTS -- ----------------------------------------------- ------------------------------------------- ....... ---- -- ------- - - ---------------------------------- Final,Inspection by: -------- ------------------------------------------------------------ ------.Dater SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 17'68 Rev. 5M