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FOR OFFICE. USE: APPLICATION FOR SANITATION PERMIT -- -- -------------- - - --------•--�---- --------- Permit No. V (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued -1-31 ----------------------------------------------------------- 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: _ T t,� f JOB ADDRESS/LOCATION . 4-� s � - ' ff � - T C NSI TRACT Owner's Name -------- I �'" 1 ! C -h 1- ---------------------------------------Phone ------------------------------------ Address ------- - 3 --------------------------------- City --r'- . . -- _ f G / Contractor's Named �---------------------------License # Installation will serve: Residence partment House�❑ Commercial ❑Trailer Court i❑ f Motel ❑Other - ------------------------------------------ Number of living units:_________`_ Number of bedroom------Garbage Grinder�_e,�__ Lot Size Water Supply: Public System and name ----------------------------------------------- ---------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ,F] Clay Loam ❑ Hardpan ❑ Adobe Fil[ Material _ o If yes, type -----_______________________ (Plot plan, showing size of lot, location of system in r ation 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' S��ze--------- _ _ __�_________________ Liquid Depth---11 --------- Ca acit Q_ Type 7__� r1 Material_ _____, ,Ah__ r�No. Compartments G . p Y -_1-- Yp JJ Distance to nearest: Well ____- -_f__________________f Foundation _.L--19--__-_________ Prop. Line _.S—/_______._.... LEACHING LINE [ No. of Lines ----�----------- Length of each line___ a0,- --- Total Length C�_____---.-- 'D' Box dc>Type Filter Material _ _U_ ____Depth Filter Material ---/_-ov-k-------------------------------- Distance t nearest: Well ___ __�-________ Foundation ---/__0___�_____-_-- Property Line _, ._-_ --------•---- SEEPAGE PIT Depth -±_- ___ Diameter __ _ _____ Number _____-� ---- Rock Filled Yes No [� Water Table Depth ----------&W--•--------------- Rock Size ------------ Distance to nearest: Wel! __;__________________Foundation %-/-0-/ - Prop. Line _s��_.....______. REPAIR/ADDITION(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 she work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - ---- -- -------- ----------------------------- --- -------------------------------------------- Own r ' B ------------ Ti#le ----------------I---- --------------- (If other than o nerj FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ------- DATE --------- -----y -------------------- BUILDING PERMIT ISSUED ----- ------ - - ----------------------------------------------------DATE - ----------------------- ------------ ADDITIONAL COMMENTS -------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------'-------------------------------------------- - - - - -------------------------------- Final = Final Inspection by: - -------- -----------------------------------Date - 1----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M