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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ! Permit No: ,� (Complete in Triplicate] Date Issued __...' -------------------------------------------- ------------------------------------ --- I ¢ If- 7 Z------------- This Permit Expires 1 Year From Date Issued 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 Rules and Regulations: JOB ADDRESS/LOCATION 07 f' - , 4 ---- ---- - .-----CENSUS TRACT -----------------------•-- Owner's Name •------------- ---- Phone - `` 7 lT- f City --- --------- Address °'� ® LC� -- ------------------------------------------•---•- Contractor's Name _ --.License # �$ 3- _y Phone �A Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑Trailer Court i❑ Mote! ❑Other ---------------------------- .Number of living units:-'C--- ----- 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 ❑ Peat❑ Sandy Loom Clay.LoamT(] �- Hardpan ❑ Adobe ❑ Fill Material _.---------- If yes,type ---------------------------- 9 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: lNo septic tank or seepage pi# permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ ] �di �_ Liquid Depth ___ _______--------------- SEPTIC TANI< Size_ `_ x =� --------------•• k CapacityrP`Egb�_�� TYP _ .--- _-------- Material_�-�-----�¢- No. Compartments ---_✓�.•.----�------•-- Distance to nearest: Well _______I fl-- ------ Foundation ---�Q__�__-------- Prop. Line ____--------------- V Y 3 ' LEACHING LINE [✓f No. 'of Lines _T'__ _______ Length of each line_----t°D--------------- Total Length _. _�o________------_-- D' Box �_�------ Type Filter. Material ---5- -------Depth Filter- Material ------ /4 Distance to nearest: Well -----1 DO--------- Foundation -------gip. --------- Property Line -------------------•-•-- d SEEPAGE PIT [ Depth _ _._�.______ _._ Diameter _��-___--� Number --------�-.- -- ---- --- Rock Filled Yes No 0 Water Table Depth --------- 5` -f ----Rock Size ---Z� �� -------- Distance to nearest: Well -----------1-c5`�d------ --Foundation /C ______ ]Prop. Line ---- -------------- t REPAIR/ADDITION(Prev. Sanitation Permit# _._---------------------------------------- Date ---- t.i 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 --------- -----------------------' J Owner U f Title ----- ---------------- ------------------------------------------------ - --------------- --- ----------- --- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY --- =---- ---------------- ---------------------------------------------------------------. DATE - BUILDING ATE _BUILDING PERMIT ISSUED ------------------------------- -- --------------------------------------------------------- ---------------DATE -------------•------------------- ------ ADDITIONAL COMMENTS ----------------------------------------------------------------------•-------------------------------------------------------- ---=----------------= �•:.�.. _;.... -------------------------------- ---------------------------------------------------------------------------------------- --------------- ------ __ t. ��`:S Inspection b - ---- ' P y= Date ---------------- Final Ins SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'6B Rev. 5M r _