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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ._7.3:---0263 ---------------------------------- ---------------- - (Complete in Triplicate) ----------I---------------------------------------------- Date Issued ----------------------------------- This Permit Expires 1 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: CENSUS TRACT -----------------•-------- JOB ADDRESS/LOCATION ._.. �T -�--- Owner's Name--- ` ' -- ----- ----------------- ---------- --" hone ------------------------------------ Address -=l _-_�... !��/- `�� i' r --------=--------License # Contractor's Name ----- Installation -----------•------- will serve: Residence] Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other ------------------------------------------- aa Number of living units-------1__.._ Number of bedrooms ___.__._Garbage Grinder ------------ Lot Size ____l Private ate Water Supply: Public System and name ________________________ ------- -- - - -- --- -------------------•-------- Character of soil to a depth of 3 feet: Sand'❑ Silt[IClay E' Peat E] Sandy Loam [ Clay Loam_E] Hardpan ❑ Adobe'❑ ,Fill Material ------If yes,type --------------------------- (Plot plan, showing size of lot, location of system in relation to'uvells, buildings;'etc: mt be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public. sewer is available within 200 feet,) Liquid Depth PACKAGE TREATMENT. [.-] SEPTIC TANK-T ] Size------------------------- -- . --- q p ----- Material------------- No. Compartments ------_---_------— \ --------------- Capacity -�------------------ Type ---------- - Distance to nearest:_.Well_-------------------------------------Foundation ---------------------- Prop. Line -------------------- = No. of Lines ' ------------ Length of,each ,line----;_------------------ Total Length -------------------• LEACHING LINE [ .] =--------- ` 'D' Box ------------ Type Filter Material --_____; ._ ._.Depth Filter Material _.______-----------•----------------- Distance to nearest: Well --------------------- Foundation - ----- Property Line ------------------------ SEEPAGE PIT [ ] Depth -----_"'laiameter ------ Number ---------------------- ___ Rock Filled Yes El No .i❑ t Water Table Depth ------- -------Rock Siie -='-------------------------- Distance to nearest: Well __________-__________________ -----='Fo -ndat+on ------------------- Prop. Line __-------_-------- � REPAIR/ADDITION[Prev. Sanitation Permit x# --------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ----------------- --------------A-----------------------------------•-----------------------: ----- ------ - � �� ------ ------- - ---- Disposal Field {Specify Requirements) ---, 1 = ----------- --------- -------- --------------- --------------------- ------ -------------------------------- -----_- ---- ------------ _ "'(Draw exisfiing and�egGred addition on reverse siai�) I hereby certify that I have prepared this,' application and that the woik will be done in accordance with San Joaquin + County Ordinances, State Laws, and Rules and Regulations-af the SaWioaquin 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, 1 shall not employ any person in such manner - , as to become subject to Workman's Compensation laws of California." Signed ------------------- ------- Owner --------------------- - -- ----- -- ---------- ----- Title By _ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ - ---- - --------------------- -- ---------------------- DATE --------------- ------- --------------- -- BUILDING PERMIT ISSUED -------- --------=-- - --------- ------------------------- - ---------------------- -------------DATE -------------- ADDITIONAL COMMENTS ------------------------------ - --------------------------------------- --------------------------------------=--------------------------- ------------------------------- _ f ----------------------------- --------- - ---- -- _Y . ---- --------- =r r Date --- �---- -. `�`'---------- ---- ---- 00 Final Inspection by: :+( -'-- ' -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M "`