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FOR OFFICE USE: APPLICATION FOR. SANITATION PERMIT f/ q� --- -- Permit No. - 'f'7�------- -- �' (Complete in Triplicate) ------------- ----------------------------- �7 7/ Date Issued�__��:""" =---=.:�------�•: -- - -- Thls Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATION ---- ""` ------� - """" __-- CENSUS TRACT -------------------------• Owner's Name �� _-------- ------ --------------------------------------------- Phone% ------------------------ _ Address -- - `,�i�- City �T------------ ie le -, ------------------------ � � ------- - ------ ---- -- Contractor's Name ,� - --------------•-=-------.License #AAS71-------- Phone - -- - - -• ---- Installation will server Residence F] Apartment Apartment House❑ Commercial :[]Trailer Court -0 Motel Other ___ __ --� � Number of living units:---/------_Numb.er-_o•f.b�edr_ocros�-,P-_.:: Garbage Grinderw___.._ ;_.__Lot size _9__"______________________________________ Water Supply: PubliclSystem and name .__ ------__ ----------------------- -- -• Private E] Character of soil to a epth oft3 feet: Sand' Silt Clay ❑ Peat� Sandy Loam ❑ Clay loam E ; Hard an Adobe Fill Material ___- ______ If yes, type ---------------------------- 1 (Plot plan, showing sizelot, .location".of system in relation to wells, building',%tc- must be placed on reverse side.) NEW INSTALLATION: (No septi®:.tic tank or seepage°.pit permitted if public sewer is available within 200 feet,) N PACKAGE TREATMENT If TANK[ ] Size----------------------------------- Liquid Depth ----------- -------------- Material---------------------- Capacity No. Compartments -- Type - ------ Distance to nearest: Well'�E � - -----------------Foundation ___________---- -- Prop. Line ---------------------- -- i ---------------------- LEACHINGV LINE [ ] No. of Lines ------------------------ Length of each line------------------------ Total Length ,.- �. ..� ---De th Filter Material '------------------------------------------ i � Q' Box TYPe:Filter Material .4 g P T ", a Distance to nearest: Well'-----"------ ---- Foundation Property Line, ________________________ I SEEPAGE PIT [ ] f • Depth -------------------- Diameter -------'-------- Number ____------------ €----- Rock Filled Yes E] No 0 f Water Table Depth ------ ---------Rock Size ----------------------- •-`------ 'sDistance to nearest: Well --- ----------------------------•-Foundation --------- -------- Prop. Line -•--------------••--- REPAIR/ADDITION{PrEv..Sanitafiion Permit# -- ----------------------------------------- Date -----` --••--`----=--_--------- _ , Septic Tank (Specify Requirements).,---------=--- ----- -- -------------------------------•--------- -------m I------ ------ -- 1 VSs .�, r ecify,.Requirements] (- _ , osai Field S --- / - -------------------------------------------- --------- ----- I - - y -: -------- ---- - -------- ------- - -- i {Draw existing and required addition an reverse side) 1 hereby certify that 1 have prepared this application and that the work will be done in acc ordance with San Joaquin County,Ordinances,:State)'L-aws,and"Rules-and-Reguiations_of-•the•Son Joaquin`Local Health District. Home owner or licen- sed agents_signature.certifi.es,.the_folIowing: 1----.sed certify that in the performance of the work for which this ermit,is�lssued,.I.shall,not'emplay any person in such manner as to become subject to Workman's Compensation laws of California." N-1 :Signe ------------ --------------------- Owner- -- ---------- ----------------------------------- _ ----------- Title 5 ------ BA - - --------------------------------------------- (lf other than owner) DEPARTMENT USE ONLY FOR DEPART � -7/"- - APPLICATION ACCEPTED BY --------------------------- -------- - DATE _ BUILDING PERMIT ISSUED -- ------------------------ DAT E ADDITIONAL COMMENTS - ---------------------------------------------------------------------- ---------------------------------- ------------------------------- - ------------------------ --------------------------------------- --------------- ----�- - -- ------------------------------------------------------------------------------------------------ ----------------------------------- ----------- ----- --------------------------------- - _ Final Inspection b Date --� ------------------------------------------------- - ------ p Y SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M