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FOR..Q :.,lr USE: APPLICATION FOR SANITATION PERMIT w f- --------= Permit No. - 6 (Complete in Triplicate} .� .. --------------------------------------------------------- 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: CENSUS TRACT JOB ADDRESS/LOCATION _!__- �`�_ Owner's Name - ---- -- --- ----------------------------=------------------ --phone Address ---------------------------------------- - --------- --- -------------`----------------. City _=------------------------------------------------------------------ ...... Contractor's Name ----------------------------------- -------------------------- License # Phone Installation will serve: Residence Apartment House°❑ Commercial :❑Trailer Court !❑ Motel ❑ Other --------------------------- ------------------ Number of living units:._____.__ Number of bedroom _--_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 Loaml:] Hardpan ❑ Adobe 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,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size---------------------------------- ------------- Liquid Depth -------------------------- ('IV Capacity -------------------- Type -------------------- Material----------- ---------- No. Compartments ---------------------- 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 to nearest: Well ------------------------ Foundation --- -------------- Property Line ________-_-_-_____._..__ SEEPAGE PIT [ ] Depth Diameter ---------------- Number ____________________________ Rock Filled Yes ❑ No 0 Water Table Depth -------- ---------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation --------------- ---- Prop. Line ______-___.._ ........ REPAIR/ADDITION(Prev. Sanitation Permit# __-----_-------_---------------------------- Date --------------------------.-------) SepticTank (Specify Requirements) -------=---------------------------------------------------- --------------------------------------------------------------------------------- Di ---------------------- t --- ----------= Dis osal Field (Spec-ify Requirements) -- 1 '--7�/=�<f�' --- '�� ---- �j/�----Nxe& --- ------�� . ,� . �� r. � -------------- h✓._ r - == - WAA---------------------------- Drd'w existing and quired ad ion on redersXside) l 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, 1 shall not employ any person in such manner as to become s"ubje t to W-grkm Compensat'on�11,w, of California." Signed -.:Lw��t °� ----- --- -------------------' Owner Sy _------------------------------- (If Title ----------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY ------------ .... --- ---------------------------------------------------- ------------------ DATE ---- BUILDING PERMIT I LIED -- - ---------- DATE -------------•---------- ADDITIONALCO �S ------------------ ------------.------------_----- ------------------------------------------=-------- ------------------ ' _- . -- , -------------------------- - -------- ------- ------------------------------------------------------- - ---- - ---------------- ---------------- fI - = �r --- - ---------------=- FinalInspection by: - -�--.1--------------------------------------------------------------- ---- --------------------------------.Date - SAN JOAQUIN LOCAL HEALi H DISTRICT E. H. 9 1-'68 Rev. 5M.