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.�R OFFICE USE: APPLICATION FOR SANITATION PERMIT --------- -- Permit No. (Complete in Triplicate) ---------------------------------------------- - Date Issued __ _".Z- -�-. 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/LOCA�TIgON ---- �-�-- -----�---� -[3.�' ------ �-�`-'-C. -------------- -CENSUS TRACT --------------------•----- Owner's Name ), � YYI �I�- ---------------------••---- Phone Address - --- -------------------------------- --- --------------• City -- Contractor's Name -- -l�! ��. 5--- �_ ��-` --- -��1!(1- -----License # ---- Phone P}tone '-- L-- ------ Installation will serve: Residence P1 Apartment House[ Commercial ❑Trailer Court ❑ 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 'E3 Hardpan ❑ Adobe'A 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,} O PACKAGE TREATMENT { ] SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth ----------.----------.----- Capacity --------------------- Type -------------------- Material-------- ------------- No. Compartments -----------•-•-------- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- LEACHING LINE No. of Lines --_---J-------------- Length of each line------------�a%I- ___ Total Length -- + ---------------- D' Box ---__.______ Type Filter Material _-____ _________Depth Filter Material ------------__------------ � ...-.- Distance to nearest: Well ------ Foundation ---l----- Property Line ______� ______________ SEEPAGE PIT ] Depth -. __ Diameter __W.f_"1Number _.___-----/-___________ Rock Filled Yes No Y❑ Water Table Depth ------------ - -----------Rock Size ---- ---------- - Distance to nearest: Well ------------------...Foundation ___a __ ----- Prop. Line ------ ------------ REPAIR/ 1T10 Prev. Sanitation Permit # -------------------------------------------- Date -------------- --------------- } Septic Tank (Specify Requirements) ------------------------------------------------------�------------------------------------,-------��,_.--------------�,•/---- Disposal Field (Specify Requirements) -------------------------- --��-------------------�-- - =1'--- f� ------------------------------------------------------------------------------------------------------------------------------- -------------------- ---------------------------------------------------------------------------------------=--------------------------------------------------------------------------- (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: "1 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." Signed ----------------------------------------- - -- -------------- ----- Owner By ------- - .c Title wc - (If other than owner) R D MENT USE ONLY APPLICATION ACCEPTED BY ------- _ ..-- ------------------ DATE ----/9 4 1/ - -- - -- ---- --- --- --------------------------- BUILDING PERMIT ISSUED ----- -- ------ - --- - - ------ - ------------------------ ---DATE -------- ---•----------------------------- ADDITIONAL COMMENTS - -- ----- - -- ----------------------------------------------------------------------------- -- ---------------------------------- -- --------- - ----- -- -- --------------- - --------------- ----------- ------- - / ---- - --- ----- ---- --_ t ------------ - ----------- - - - --- - Final Inspection b Dae ---- -- ------------------- - - ------- SA/N JO QUIIv L CAL HEALTH DISTRICT ��. 9 1-'68 Rev. 5M