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FPR OFFICE USE: � � APPLICATION FOR SANITATION PERMIT � ' (Complete in Triplicate) Permit No. __<�If__..__" --------------------------------------------------------- This Permit Expires 1 Year From Date Issued 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 tmade/in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT ON .----1--#11--36--I ------- J__,�v------------------------------------------------ TRACT -------------_----------- Owner's Name -------- -- ---- C ---- -- -- -------- -_ Ph ne Address --- --------------------------- V 1= -(©---1-------`--- . City - = p ---------------- ------/- -Contractor's Name ----------- ``�` a t_ License #�lC�_?a-'j_'_�hone Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ------------------------------------------ Number of living units:_______ _,`1 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 Loam ❑ Clay Loam;❑ 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 [ I SEPTIC TANK,� Size_ '__X._�.�___�__�2_____._____-___-_ Liquid Depth -_______________ ff`, Capacity Y�_7_�__ Type Material_d_pu _4___ No. Compartments ... ................. Distance to nearest: Well _ 9n-------------------------Foundation ---------prop. Line ...... � LEACHING LINE No. of Lines _ � ___�_ ____________ Length of each line------.e��___._______-------- Total length -11;rp..___.______. 'D' Box dr_ __ Type Filter Material/ Depth Filter Material 1.1 --'--------•---------------------•- s Distance to nearest: Well G?_�____________ Foundation --E________-__ Property Line ___ ............. SEEPAGE PITDepth ____ Diameter _ -_-- Number ____�-________�� -- Rock Filled Yes JK No 0 i. Water Table Depth -----��;-------------------------------Rock Size/------1-3-P_________-_______ Ori s Distance to nearest: Well __. _______________________Foundation _, J____..__- Prop. Line ...0—..--- -_........ 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 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 ------------------- ---- -------------``--''- ---------------------------------- Owner By --- --------------------- -- ------ ----- f -------- ------------ ----------- Title ------------------------------------------ (If r than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------- ---------------------------------------- -------------. DATE -----/01 --------- BUILDING PERMIT ISSUED T' - DATE -------------•-----------------•----------- ADDITIONAL COMMENTS _1C� _3i_ _ ._____________ --- _- -------------------------- � �� ; - - -- -- -----------------------------------------:--------------------------------------------------------------------------------------------------------------------------------- - FinalInspection by: ------- ------------------------------------------------------------------------------------ -----------------Date ------ SAN ----SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M