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j - I FOR OFFICE USE. �—*� APPLICATION FOR SANITATION E _,��T --------------------------=----- ----------------------- (Complete in Triplicate) Permit No.7/ z-•9-- --------------------------------------------------------- This Permit Exp i Year From Date Issue Date Issued Ains pplication is hereby made to the.San Joaquin Local Health District for a ` described. This application is made in compliance with Cou ty Ordinance No. 549 and existing Rules It' the Regulations.rein t , JOB ADDRESSAOC TION _ ------- CENSUS TRACT _ - Owner's Name / _.._ one Address /-✓� , ---- City Contractor's Name - --- -----------License # �r Phone Installation will serve: Residence -Apartment House❑ Commercial[Trailer Court ❑ I "Motel E:1 Other -------------------------------------------- Number of living units:------------ Number of bedrooms ------y Garbage Grinder ---_-------- Lot Size ----- f I ; Water Supply: Public System and name _____________ ------------------ ---------------------------------•---------------- Private ..- Character of soil to a depth of 3 feet: Sand ❑ Silt E] Clay ❑ Peat❑ Sandy Loam -E] Clay Loam I Hardpan ❑ Adobe ❑ Fill Material ----------- If yes, type_____________-______ (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tdnk orseepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC'TANK [ 7 Size-- ----------------------------------------------- Liquid Depth ----- ---------- - w Capacity--�--------------- TY pe - Material---------------------- No. Compartments ------ w Distance to nearest: Well Foundation Prop. Line - -•---------- 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 --------------------- ------------------ - --- SEEPAGE PIT [ ) Depth ------ ------------- Diameter ________________ Number, --------------------------- Rock Filled Yes ❑ No Water Table Depth ______________ ----•------•-------------=-••-----Rock Size --- --------------•------- ----- Distance to nearest: Well ------------------ ------------.._..Foundation -------------- ---- Prop. Line ----------- REPAIR/ADDITION(Prev. SanitationPermit�# ____________________ __ _-_____-___ Date ------ Septic Tank (Specify Requirements)_ ____________________ Pis-Rosal Field (Specify Requirements) r� ,,-- ------ ------ ;a�---------- --- ---- --------- -- ---- ----- 3 x �- s - ---- - --------- ---------------------------------------------------------------------------------- ----------------------------------------------- raw 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 o10,1the work for which this permit is issued, I shall not employ any person in such manner as to become subject to War n's Compensation laws of California." Signed --- Owner - ---------------,-- - (If other tha wner) ------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ------- ------- DATE _'_r 4_` �_--- -• -- - •----------------- ILDING PERMIT ISSUED --------------- ----------------------- ----------------------- ADDITIONAL - --•---- ---------------------- ------------------------------- -----------DATE -----------------------------------------•- ADDITIONAL COMMENTS --------------.�1------------------------ _-_-- - _ •- - - 1 - - ------------------------------------ ( ------------- --------------------------------------------------- ----------------------------------- --------------------------------- --------------------------------- ------- ------ ---•-- Final Inspection b --------------------------------------------- ----- ------------------------------------------------ Date -- - f1 SAN JOAQUIN LOCAL HEALTH DISTRICT