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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...........•...............................•-----------• Permit No. ..7�,:'l`.�..:Z. (Complete In Triplicate) ............. .. ...... This Permit Expires 1 Year From Date Issued Date Issued 1 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: .............CENSUS TRACT JOB ,ADDRESS/LOCA I N -/..��Q.�_9 ...�.._ �i:f..... ..�............... ......,.._............._.. Owner's Name .. -r --•.....:............................................. 4...............Phone .................................... Address .......:..�.� . .- _.._._.. ... 1�.�___• ...City ...�~ .. Contractor's Name �.. 1.447.- ........License # Phone iInstallation will serve: Residence dA.partment House Commercial❑Trailer Court � Motel ❑Other ................:..............•.......*... jNumber of living units:.... ------ Number of bedrooms Garbage Grinder ............ Lot Size ................... : ..................... Water Supply: Public System and name .............. ...................__.. ................Private Character of soil to a depth of 3 feet: Sand[I Silt 0 Clay [Q Peat❑ Sandy Loam� Clay Loam D I Hardpan [] Adobe 0 Fill Material Y type' •-.......... If es a ............... •---•----•-- (Plot plan, showing size of lot,-location of system in relation to wells, buildings, etc: must be placed,an,reverse side.( NEW INSTALLATION: (No septic tank or seepage pit permitted.Ifpublic sewer is available within 200 feet,( PACKAGE TREATMENT f SEPTIC TANK } Size..........................::.......•---•--._-_ Liquid Depth .......................... Capacity -------------- Type . ----------- Material..:.............------ No. Compartments .....................� Distance to nearest: Well ..................................:.Foundation ...................... Prop. Line ......................G LEACHING LINE [ ] No. of Lines ------------------------ Length of each line............................ Total Length ....................•........0 i '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 ❑ ...._�� Water Table Depth ------------------------------------------------Rock Size ....... ........................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/AODITION(Prev. Sanitation Permit# ...........--------------------------------- Date ........................ 3• SepticTank (Specify Requirements( ---------------•--•-------------- .............-------------------....-.•----------•------------•-•...............__.....__.......I...... -T D' posol Field (Spe ify Requirements ...o__ !% , ___ _`. .._ _-- - A ave ----------•.--------•- ----------------------------------------------------------------------------- -•---•--------- (Draw existing and required addition on reverse side) I .hereby certify that 1 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 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." I{rF Signed ------------------ .. Owner By .......................... Title k (If other than owner) _ O EPARTMENT USE ONLY _ APPLICATION ACCEPTED BY _- ...- . -..- . _ .. - •- --- -•- ----...._•- DATE . .............--- - -- ------ BUILDING PERMIT ISSUED -------.''_.........................•--------------- ,... ....................•---------------• --------------DATE :.....-----_.:....:.---...----------••-�.. : ADDITIONAL COMMENTS ----- --------- -----------•----•--•- --------------------------------------------- -•------•--------•- ---------•---------•-------------•- ------ --• ........ -----------_--------•.............-..... ..---••------•................•-•---..........---- Final Inspection by �.- Date _..��_�/. ._ ` ER 13 2a 1-68 1-ov• 5m SAN JOAOUIN LOCAL HEALTH DISTRICT 8/7h 3M t