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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ...... ------------- This Permit Expires 1 Year From Date Issued 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 . . ./. �v. : - -"_--- _tu........- "CENSUS TRACT Owner's Name ..._.r'1 IG7. � . _ Gl _. ------- _4_ -.& - -- = u.. ••. -•-•- Address f / _..... Phone `' City 1y, Y. d ..................................... --- y- •---•---------•----•---� Contractor's Name -_---_ - "--- ---,�- •------ -------License �c�.9/._�Phone Installation will serve. Residence{$'Apartment.House❑••Commerciaf:❑Trailer Court ❑ Motel ❑ Other--------....................... ------------- Number of living units:----.1__._ Number of bedrooms ...•��' ..._Garbage Grinder ------------ Lot Size f �' �- Water Supply: Public System and name .-_ ............................................ •--------------------•------•• Private Character or soil to a depth of 3 feet. Sand P] Silt E] Clay [] Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan [] Adobe 0 Fill Material --- --------- if 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) f PACKAGE TREATMENT { ] SEPTIC TANKSize Liquid Depth _.___. _ - Capacity _------.- ---- Type ""--------' ------ Material-.---..-__._-- --..--_ No. Compartments ...---------------•--- Distance to nearest: Wel! --_---__--- -- -• _--•-----_---..Found ion --------------------- Prop. Line ---- LEACHING LINE Total Length -------------. [ � No. of Lines •.__._.__.__.._.___._._ Leng of each line________ ___ ____ __ __ ___ 'D' Box --.-__._._._ Type Filter Mate ral ______________-_._.De Filter Material Distance to nearest: Wel! ____.___ Faundatio ------- Property Property Line _ SEEPAGE PIT [ ] depth -----.---------..__ Diameter "--------------- Numbe- _..-.---_-.__.___.-•-.__-__ Rock Filled Yes ❑ No ❑ Water Table Depth __....__..--•- ----------------------- ------ ock Size ............. Distance'#o nearest:. Vs/elJ. ------ ..-•---.. --------- __Foundation ..- -:.. Prop. Lina __...... -•--- REPAIR/ADDITION(Prev. Sanitation Permit 5 __._.. _ _ __-- ._; �.... _ Date --___________________.r_._ Septic Tank (Specify Requirements) _-.................. ------------------•:........ ......................__,._......_....w..._...�.._._--------•----. Disposal Field (Specify Requirements) ------.�J' ......., - �. . .... (Draw existing and required addition on reverse side) _ 1 hereby certify that I have prepared this application and that the work will be done inaccordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local l;feaalth 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 trot, employ any person in such manner � as to become subject to . a4man's ompensation laws of California... I' Signed ---•• -•.:.-- .. -owner .. � 11 . --••---•- ...:.. .weer By _. ...._. .:.. Title_"...... ' {If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- c,1S�.. -------------- ........................... DATE ..... ^ - r BUILDING PERMIT ISSUED ............ • - .... .......................... ADDITIONAL COMMENTS ----- _... - -" DATE --- �;. --•----------- ---•---- ----------- - .... •-- Final In 1. t .. ... .. ........"- ----__Date-- ........-- ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H, 9 1-'"68 Rev. 5M ;