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FOR OFFICE USE: APPLICATION.:PORmSANITATION PERMIT --------------•---------------- (Complete in Triplicate) Permit No. - --------------------------------------------------------- Date Issued ------------------------------------ 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. Thi-- rtnnli..+:.., ,ode in compliance with County Ordinance No. 549 and existing Rules and Regulations: J013 ADDRESS/LOCATI NL.'8. - �`' �-- f NSUS TRACT �-y------------------------- Owner's Name ------- @-------- ------ - - -----------------------.---------------- •--------- -- Phone _:` -7-: - Address - ------- ------------ ! f `�" '--•------------ ----------------------------------_- City ......// ------------------------------------------------------ Contractor's Name -- -- ---------------------- ----.� lJ--------------------.License # !PP S1I------ Phone 4I_61_-9607___ Installation will serve: Residence ❑ 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 K Clay Loam 'E] Hardpan ❑ Ado'be ❑ 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,) �l / i PACKAGE TREATMENT [ ] SEPTIC TANK)d ----- ize---___- -_ __ �__`_ '_�___._ __.-_ -_ _ Liquid Depth ___,.�� �1 _ __________- Capacity / _ Type _-►5.�'tiF_____ Material_ C1_ No. Compartments ____�_-___....._ Distance to nearest: Well _______ —-----------Foundation -----/_ ----- Prop. Line LEACHING LINE No. of Lines __-____ ---------- Length of each line--____/00__-_-_.____ Total Length --- .......... Box _____°�Type Filter Material p r� Depth Filter Material ---------------------- --- Distance to nearest: Well ____�� "r______ Foundation _____-�__�. _-_ Property Line ---�.I__�`__-____ 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) ------------------- -------------------------------------------------------------- ---------------------------------------------------_----- 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: "I 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 �- .. =------- -------- (if , other t owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------� = ------------------------------------------------------------------------ DATE _ _�./=7?. ------------------- BUILDING PERMIT ISSUED -- ------------------------------------------------------------------------------ ----------------------DATE -------------•----------------------------- ADDITIONAL COMMENTS ---------------------------------------------------------------------------------------------------------------------- ------ --------------------------• -------------------------------------------- -------------------------------------------------------- ---------- -- ---- ----- -- --- -- Final Inspection by: �= ----------------------------------------------Date -3 1r --------- SAN JOAQUIN LOCAL HEALTH DISTRICT } 4LA E. H. 9 1-'68 Rev. 5M t