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POR OFFICE USE: APPLICATION FOR SANITATION PERMIT --` :- Permit No-�.�.`.. ----� (Complete In Triplicate) s s 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 made in compliance with County/Ordinance No. 549 and existing Rules and Regulations: JOB ,ADDRESS/LOCAT N .�� 5 v .. 9-f - --------'- Li- .G �, �.,.rT.... CENSUS TRACT ........................ Owner's Name ---....E_ :.�� ... ------------ -.Phone ....... ................. - Address ....._...o..Z.S -. ?I......d. ................ City - - - ..... Contractor's Name ... _License s /�l3y .. Phone .......................... - Installation will serve: } Residence[Apartment Housi ❑ Commercial (]Trailer Court 0 Motel [:3 Other -------------------------------------------- Number -'•--•-----••-• -- ---"---•--------- Number of living units .,_. _.. Number of bedrooms .2-------Garbage Grinder f�=5... Lot Size _.................................... ..... Water Supply: Public System and name ------------------------------------------------------------ --..........................................Private Character of soil to a depth of 3 feet: Sand o "IIt Q Clay ❑ Peat El Sandy Loam ❑ Clay Loam fff ❑ I Hardpan "Adobe 0 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.) p .NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) t PACKAGE TREATMENT [j ,SEPTIC TANK{ I Size..__s ... ....................................... Liquid Depth ....................... Capacity ......'----- ... Type .... ------- Material...................... No. Compartments ................. o 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 toInearest: Well . . Foundation __-------------------: Property Una, .............__... .. SEEPAGE PIT! [ J .Depth ----- ------------- Diameter ...... .... Number .._-_................----.`. Rock Filled Yes 0 No ❑ ' N✓uter Table Depth ............- ---' - -•-•.....................Rock Size •---------- .................. ,Distance to nearest: Well _1:.........r..-----_::...........Foundation _.... ..... Prop. Line ......... REPAIR/ADDITION(Prev. Sonitation Permit :.................. Data ...........1....... I � i Septic (Specify ReJuirementi4) ............... --;'f ._d.u............... - - - of..t.p....f .-.., _.............. re eats)Disposal Field (Sp : � Z .._ ... 6......x. -. -L_. . . .........., . . __ L !. ...... . ..---.. ............ '(DrCw existi 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 e`F 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 _... - Title .... -....................... _ By - — (If other than owner) ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... .-------------..... . .............................. DATE -------._ BUILDING PERMIT ISSUED _... ......__ __----------------------------___...............------------------------DATE .. ... ------ ---.............-. ADDITIONAL COMMENTS ..... ........... -- ...... Final Inspection ................................................ -------Date =-•T--�. p. ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M