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I FOR OFFICE USE: APPLICATION FbR SANITATION PERMIT ------------------------------------------ -i-& ------ Permit No. J - (Complete in Triplicate) ---------- -------------------------------------- Date Issued ------------------------------------------- l- This Permit Expires 1 Year From Date Issued t 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: --`®--__-:---- --- ---� 1 r CENSUSTRACT -------------------•--__-- 5---- ----- ------------------- - JOB ADDRESS/LOCATIO - - -------- -------Phone `---- ----------------•--- Owner's Name -- - - --- - -- -- Address __e } d r yam-_ --�- - ---------------------------------------------- ---- __ d_ ' - . cit Contractor's Name ------ - ------- ------ ----- _.License # _� ��_ 'Yphone - Installation will serve: Residence Apartment House-[] Commercial ❑frailer Court ;❑ Motel ❑ Other --- ------- Number of living units:------ Number of bedrooms ____^--_____Garba_ge Grinder --_-______._ Lot Size __-_�j��`�' --------- F _ I -- Private Water Supply: Public System and name - ---------------=-----------------------------------------------•-•--••------------------------------------ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay .❑ Peat ❑ Sandy Loam Clay Loam"E_] 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 f ] Size-----------------=------------------------- ---- Liquid Depth ............. --------_- Capacity ----- ----- -------- Type -------------------- Material---------------------- No. Compartments ------•------•--- t Distance to nearest: Well ___________________________________!Foundation ---------------------- Prop. Line ___________________. liy LEACHING LINE [ ] No. of Lines ------------------------ Length of each;line---------------------.------ Total Length ------------ ---------- -'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------._---------------------- Distance to nearest: Well ________________________ Foundation ------------------------ Property Line -----___-___•---__._-_._ �4 SEEPAGE PIT [ ] Depth _____________ _____ Diameters_---------------- Nurnber ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ----------------------------------------- , _Rock Size -------------------------•------ p Distance to nearest: Well ---------------------------------k------Foundation __________________ Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit a# ________---------------------------------_-- Date ----------------------------------I )f `-- -------------------•- ~ Septic Tank (Specify Requirements) --;�--- - --------------------�------,^------------------ ---- -------------------- -- ------------------------------- ------------------------------------------------------ Disposal Field (Specify Requirements) -- ------------------ ------------------------ ----- ------ I { ------------------------ -- ---------------------------------------------- ------------.. -------- ----------------- _42 (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: IF "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 became subject to Workman's Compensation laws of California-." - - - --�--�-- - -- Signed --------- -------------- - Owner ---- ---- -- --- -- -- --- By --------------------------------- ------- Title - ------------------------------ (If other than owner) FOR DEPARTMENT'-USE ONLY .- ------------------------- ------------------• -------- -----------------=------ ---------------- APPLICATION ACCEPTED DATE BUILDINGPERMIT ISSUED ---------------------- ----------------------------------------'------- ----------------------DATE --------------------- ------------------ ADDITIONALCOMMENTS ---------------------------------------------------------------------=------ ---- -------------------------------------------------=---------------- -n------ - --------------------------------- 1/ ----------- ------------- ----------------------f' ------------ - ------------------------ 1 final Inspection by: --------- `'" ` r-------- Date ---- ---- -- ---------- SAN JOAQUIN LOCAL HEALTH'DISTRICT � E. H. 9 1-'66 Rev. 5M