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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......................................................... Permit (Com l ...................... -------------- ........... .... ....-..._..... p .p Date Issued ��.� ete in Tn licate) .•----------------_-----_---_-._............... This Permit Expires 1 Year From 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: ev 4 JOB ADDRESS/LOCATION - _ -. ry CENSUS TRACT --------..--.._-_--- Owner's Name ^ .................... ---------------..----- . .... •.......__.......Phone......------••--•----..... .......... Address _..� ��s. -._•� City _. 40257i� Contractor's Name .-(r r License # Phone t7' Installation will serve: Residence �4ment House❑ Commercial oTrailer Court t3- Motel []Other ................................ ............ 4 Number of living units:............ Number of bedrooms ..44�------Garbage Grinder ...........- Lot Size .__.............._ ...................._.... s i Water Supply..,Public System ondTname __________. r.. -....................... - ,Private 2?_ Character of soil to a depth of 3 feet: Sand[] Silt o Clay ❑ Peat Q Sandy Loam ❑-%�•Clay Lodm;Q 1124 74d Hardpan ❑ Adobe'Q Fill Material ------------ If yes,type.-- ------------=-- 1 (Plot plan,.showing size of lot, .location of system in relation to wells, buildings'etc. must be.placed or reverse side.) NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer is available within 200 feet,)_ PACKAGE TREATMENT [ I SEPTIC TANKI ] �+," Size----------------------------------- ----------- Liquid"Depth �l ............... a � } Capacity �� 'f . Type _Lk�e1 ater'kal._-__-•............. No. Compartments i Distance to nearest: Well ._.f��.........................Foundation ............. Prop. Line..............._...... S'C LEACHING LINE [ ] No. of Lines -4'................... Length of each Iine.7O....____...__._.___- Total Length ..2.-_____._._- .......... D' Box __`4---.. Type Filter Material ... _Depth Filter Material .'. - .....:............................... _ Distance to nearest: Well ------ ..... Foundation ......................... Property Line. ................. SEEPAGE PIT [ J depth .......y............. Diameter ................ Number ....________.___........_... Rock Filled Yes ❑ No C Water Table' Depth ...--------•-- -- ==-•---•- •---.-...Rock Size -•------•---•- ................. Distance'to nearest: Well ..................A_...._______........Foundation --.__-----.._..----- Prop. Line.................. � { REPAIR/ADDITION(Prev. Sanitbtion Permit# ............................................... Date _-____-----.-_ ------- ---_------------ -. -- -- ---- -- -----••-----..._....------....... --------.............................- .................. y +i Septic Tank IS ecifY 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 Hcen- 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 i as to become subject to Workman's Compensation laws of California." Signed L` -------------------------------------------------------------- Owner ` By ......... ......... .................. --------•-- •- ----------------•------------•---------- Title ----•-- ....................._.................------------ ---_-•--- (If other than owner) FOR DEPARTMENT USE ONLY 7 47- APPLICATION ACCEPTED BY -._......_.. _�....------------------------ ---------------------------------------------- DATE ..7��(.._- BUILDING PERMIT ISSUED............. r-� DATE .... ___..... ADDITIONAL COMMENTS __._. ?a..lr�f u w -. � x-�.� _. ........................................................... .............. ........---------------•--•---------- --------.-----------••--------------------•---•-•//�/� •............... ...................... ............................... Final Inspection b ... .Date ...... . ............•.. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ,r.