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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT------- -- ----------------- ----------------- Permit No. 3--7 (Complete in Triplicate) I / Date Issued __"_________________ - - _ This Permit Expires l Year From Date Issued /e i Application is hereby Imade to the San Joaquin Local Health District' for a•permit to construct and install the work herein described. This applications m&de.,incompliance.with'County'-Ordinance'No. 549 and existing Rules and Regulations: -- - _CENSUS TRACT- --s�.----.-----. JOB ADDRESS/LO II -- --/-- -------- --- --- - - I ' Owner's Name ----- -- - ---------- ---------- - -- ------------------------------ Phone Address -7l -��'�-- -- CitY . r Contractor's Name --- -- --- -- _ -.License /? �-- '-Phone -----------------•---•- Liv # - Installation will serve: Residence ApartmentHou e Q-Com17 ❑Trailer Court ',❑ � Motel ❑Other -------------------------------------------- Number of living units:_____;____ Number af.-bedr`ooms -_____�'Gar��e Grander -------t----- Lot Size ----_------------__________._._________.___ , Water Supply: Public System and name ----'------------ -- ' °------•-------------------- -------------.------------- --------------------------_Private` Character of soil to a diepth of 3 feet: Sand❑Silt❑ f Clay ❑ IPeat❑ Sandy Loam .�e Clay Loam ❑ - Hardpan ❑ Adobe ❑ Fill Material----------- If yes,type _____________-"------------ x (Plot plan, showing size of lot, location of system in relation to wells, buildings,`etc. must be placed on reverse side.) NEW INSTALLATION: .I (No septic tank or seepage pit permitted-if public sewer is available within 200 feet,) III = r PACKAGE TREATMENT SEPTIC TANK ANK [ l Size--------------- - - ------ ----------- -- Liquid Depth ------------------ ------ Capacity V -w.. � � !_ . �� \ . Type ____________________ Material_-.______"". __._._ No. Compartments -4Yp GN Distance to nearest: Well _______________________________----Foundation ---------------------- Prop. Line _____--.________------ LEACHING LINE [ } No. of Lines .----------------------- Length of each line---------------------------- Total Length _.____-.________-.---__._._. 'D' Box .____ ------ Type Filter Material ____________________Depth Filter Material ------------------------ -------_. -•- Distance t& nearest: Well•s;____-.------------------- Foundation ------------------------ Property Line ----•------------------- SEEPAGE PIT [ ] Depth Diameter ________________ Number --------------------------- Rock Filled Yes ❑ No 0 WaterTable Depth ---------------------------------------=--------Rock Size ------------------- ------------ Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ... ............. REPAIR/ADDITION(Prev. Sanitation Permit# ________.____________"- ---------------- Date ---------------------•-----•------) ' � I Septic Tank (Specify Requirements) ------------------ --------- -- --------------�---------------- ------------ i Disposal Field (Specify Requirements) - --- _ -------- -- - iN -o---- ------------ ----- - �-� -- --- ` �' ---- -- --- - - - -- -- - I� ( a 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 in the performance of the work for which this permit is issued, I shalt not employ any person in such manner as to become subject to Work Compensation of California." Signed -----------------------I�--- ----- ------- ----- -- ----- -- --- - ----- - Own �, l"� I .1I . -- ------ Title (If othelfhan owner) . FAR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------------------------- DATE '---------------------- BUILDINGPERMIT ISSUED -----------°------------- ---------------------------------------- -------DATE -------------•--------------------------- ADDITIONAL_ COMMENTS ----------- Z----------------------------------------------------------------------------------------------------------------- -- --------------------------- ----------------------------------------------------------------- ----------------------------------------------------------- ------------------- -- !'. ----- Final Inspection by: __.II �?'? � ------------- -----. Date "j --------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT Imo, E. H. 9 1-'68 Rev. 5M.