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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------- -------------- (Complete in Triplicate) Permit o_ ____ _________ ................... This Permit Expires l Year From Date Issued Date Issued --9.6_ y_ 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/LOCATION -------7..... .............. ._/ ''--- .......................CENSUS TRA T __.__ ---- Ap Owner's Name ------ � p ----- - ---- --..Phone._ �Q Address .............. ------ 11.- -------••------- ------City ------•----•----. --•---f---------- --------•----------•-----•------ Contractor's Name •- ------Izz ----• -•------•---- --------------- ..........License* -•-------:---••--------- Phone .............................. Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court I❑ Motel ❑Other . ...... ----•------ -- Number of living units:----_/.. Number of bedrooms _.Garbage Grinder ------------ Lot Size WaterSupply: Public System and name --------------------------------------------------------- ------------_--••----•-- -----------------------_Private V Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay El Peat❑ Sandy Loam Clay Loam Hardpan ❑ Adobe'❑ Fill Material ............ If yes,type....... --_-------------- 1 (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 [ ) SEPTIC TANK:[ ] Size-.,,....................... _-_----------..-- Liquid Depth ..._._.__._.- ....... Capacity -------------------- Type -_-- ------------- Material_----.._...-------..._ No. Compartments -----_----_. 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 [ J Depth ----------- Diameter ________________ Number ---_...._.__-...____.___.__ Rock Filled Yes ❑ No C] \ Water Table Depth --•-•--•-------------------•----•-----------•----Rock Size .--------------•-----•-------- Distance to nearest: Well -------------- _......................Foundation ------------------.. Prop. Line _...-______.___-_,__.. REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date __--___-..._-..--___.--__._-___.._} Septic Tank (Specify Requirements) -------------------------------- -------•------•------ / -- - Disposal Field Specify Re, ments} l . FL/�� .. .. �y _ J .d-----�v� /-IfZ -------------------------------------- - -------- -•------ . ----• ------------ --------------- (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. dome owner or licen- sed agents signature certifies the following: "I certify th i the performance of the work for which this permit is issued, I shall not employ any person in such manner as to beta e t arkMnCo.mpenstition laws of California." Signed '_ --------••-------_....-..-------------------- Owner By --- -------•••-----------•--••-----------•••-------------------- . .--------------- -Title .-•--- -- ------ (If other than owner) FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... -•----- - e• f ....... --------- DATE --• a .. ... BUILDING PERMIT ISSUED --------------------------------------------- .........DATE ------.------------. ADDITIONAL COMMENTS ............ - ---------- ........ ............ - --------------------------------------- ..................- •----•-- ---•-----------------......----------- -------• ------------ ...... --•------------------•--- -------------------- ............................................................................................ ----••--••-•- ........... Date ...._. _. asFinal Inspection by: ._ ------------- .. ......... SAN JOAQUIN LOCAL HEALTH DISTRICT F. H. 9 1-'b8 Rev. 5M ��