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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7v ------------------------------------ Permit No: (Complete in Triplicate ----------I---------------- --------------------------- Date Issued f 6 -- 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: JOB ADDRESS/LOCATION .__! d -_-- - ------ --- ------------ ----------CENSUS TRACT -5Y.1-------------- Owner's Name �� -- -------------------------Phone ---------------------------------- AddreAddress 041" ss -----�-�-�--- �'-------! -- --��- -------• City ---- - - --------------------------------------------------------•---•-- Contractor's Name --- ---- _ _ _ _ ofA1Z-o __.License # ---------:-------------- Phone ____________________- - -- - - - --- - - ------ -------------- --------- Installation will serve: Residencce�artment House Commercial : Trailer Court C Motel ❑ Other Number 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'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ____________ If yes,type ____________________________ U (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 T I Size---------------•-------------------.------- ---- Liquid Depth --_-----------------.,..._. Capacity -------------------- Type -------------------- Material---------------------- .No. Compartments ------ ----------•---- Distance to nearest: Well ________________________________Foundation ---------------------- Prop. Line ________________-_---_ LEACHING LINE [ J No. of Lines ________________________ Length of each line----.----------------------- Total Length -----------v_________-_____ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------------------.------ Distance to nearest: Well Foundation ---Zj�------------- Property Line ____��7--_______._.___ SEEPAGE PIT l,�+i Depth -2—__C_......... Diameter SJ------- Number —/0------------------- Rock Filled Yes,Eo No i❑ Water Table Depth -1--Q--------------------------------------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: "t certify that ' orman of th ork for which this permit is issued, I shall not employ any person in such manner as eco e o Wor an' pensation laws of California." Signed --- -- -- ----- --- - - - Owner BY ----- ------ ------- ------------------. Title -------- -- ------------------------------------------------------------ ----- ---------------- ------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ _____ _ __ _ _- -- ------------------------------------------ DATE ------ ��-- BUILDING PERMIT ISSUED -------------------------- - --- L_ ----=--------------DATE -------------•-------- '---- ADDITIONALCOMMENTS --------------------------------------------------------11---------------------------------------------------------------------- -------------------------- ..------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- -------- ------------ --- - -- -11�1- -(r---- 5 --------------------------D ✓rFinal Inspection b -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 • 1-'68 Rev. 5M