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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �g Permit No- -------------------•-� --------- - ------------------------ --------------------- (Complete in Triplicate) ------ --= ----- ---- ----------- ------------------ Date Issued This Permit Expires I 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 ounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI N . -_� ® - -- ---------- --------CENSUS TRACT ---- --------------------- r Owner's Name ------ ----- ---- one Address @ --- ---- -License - ---- -- ---- - f , i License # --�j,�� -Phone ------------------------------ Contractor's Name .__.___._ --- �- ---- Installation will server Residence E] par ent House❑ Commercial ❑Trailer Court i❑ Motel ❑Other __-------------------------------- Number of living units:- - Number of bedroonT�-----Garbage Grinder ------------ Lot Size ------------------------------- I Water ----------------- ------------ Water Supply: Public System and name -------- -------------------------------------------------------------------------- ------ ---------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ----- ------ 1f yes,type ---.----_-._--------------- {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: lNo septic tank or seep a pit permitted if public seer is available within 200 feet,)44 r /��_ _ ` - Liquid Depth ---------•------------ PACKAGE TREATMENT { ] SEPTIC TANK'[ Size__ _ _____ __ ___ _ __- Ca Capacity �D Q- - Type �-- MateriaY��`-e-4149--- No. Compartments pY---�--•----- p Y --- ------ - -- YP Distance to nearest: Well ---...'0.0- f--------- -------Foundation ---_-I a- `------- Prop. Line -----`�-------------- LEACHING LINE [ -----1--------- ----- Length of each line------/0 ------_------ Total Length ____j- - --•----------- No, of Lines _- re 'D' Box __j -- Type Filter Material ------3---- --Depth Filter Material --------- -f�----------------•------------- Distance t nearest: Well ----- ------ Foundation -- ------ Property Line ----------------------- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No I❑ 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 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 licen- sed agents signature certifies the following: "I certify that inftheerformance of the work for which this permit is issued, I shall not employ any person in such manner as to become suorkman's Co ensat n laws of California." Signed ---------- -- . . -------- --- --- Owner By - --- 0 P title -. _`-'----- ------fi t -------------- ----- (If other than owner) µ f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- ----- DATE --.2 --s�- -- -- - ----------------- - - ------------------------------.- - BUILDING PERMIT ISSUED -------------------- -- ::DATE, ADDITIONAL COMMENTS -------------------- - -- -------- --------------------------------------------------------- ----------------------- - ---------------------------- - Final Inspection by: .____ Date .3_ . --- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M