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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �y ---- - - --- ----•- ---- ----- - ---- Permit No. ! (Complete in Triplicate) ------ -- -------------- -------------------------- �7�9 Date Issuedt--__� _ ____. This Permit Expires i Year From 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: i JOB ADDRESS/LOCATI N = ® + --- ------------------------------- --- ----- --- '.__CENSUS TRACT _--------------------...-. Owner's Name - aQ -----=--------------------- Phone -------------------------------•- Address O --- �---- ------------- -------- Y //�1� ! � license # /9f 3_1P rPhone --------------------_ ---•-- 5, Contractor's Name ----- ----- - ------ `. t.-- Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court l❑ ( Motel ❑ Other -------------------------------------------- Number of living units: --_r____,_ Number of bedrooms ____ _ _Garbage Grinder ------------ Lot Size ----- r� Water Supply: Public System and name - -------------------------------•------------------------------------------------------------------- Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E] Peat F] Sandy Loam ❑ Clay Loam [g/ Hardpan❑ =Adobe_'❑, Fill Materia! ----- ------ 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-I (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �'PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------------------------------------------ ---- Liquid Depth ---------------------.----- Capaci Type -------------------- Material______________________ No. Compartments t Distance to nearest: Well ------------------------------------Foundation _-- --.--------------.Prop. Line --_-----.. ---------- LEACHING LINE [j No. of Lines ----------- ------------ Length of each line.--------=------------- ---.Total LLength... �F ' - 'D' Box Type Filter Material ------------------- Distance- -Depth Filter Material ----------------------------------------__._ -- y: -•---�--�—� - to"nearest:_Well ------------------------ Foundation ------------------------ Property Line. ------------•- -- SEEPAGE PIT [ ] Depth ---i---------------- Diameter ---------------- Number -----.-------------- - ------ Rock Filled Yes C] No IWater Table Depth --------------------------------------- --------Rock Size -------------------------------- i � 4 Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------•.............. REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------- Date ---------------------------------- I Septic Tank (Specify Requirements) k Requirem tian—ts) ------------ ( j Z-Ea - - ----------------- Disposal Field (Specify Requirements) - - - - ----- !r ------------------------------------------------------------ ------ ------------------------------- i (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 Son 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 sub' Workman's Compensation laws of California." Signed ------- - -- - ----------------- -------------- ---------------------- Owner r BY Title ------------ - ------------------ -- -------------------------------- - ----- ----------- (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ____- _________________ DATE _ --�.��`� --=------------ - - ---- --------------------------------------------------------- BUILDINGPERMIT ISSUED --- -----'------------ ---------------------------------------------------------------------- ---- DATE - ADDITIONALCOMMENTS ----------(-------.---------------------------------------------------------------------------------------------------------------------------- ---------------. ---------------------------------------------------------------- - - - I ------------------- ----- Final Inspection bY: --------- Date s f9 - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -�