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- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �. ............. (Complete in Triplicate) Permit No. � Date issued .• .....- . ......... . .... This Permit Expires 1 Year From bate 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�LOCATI49 ON€ ..T� ._ �.!y �.... ,J Owners Name ,. N /� ._.._.. ......................... ....................Phone Address ..... �' ?lj" = Ci �i . lf�_... Contractor's Name License # Phone _.. Installation will serve: Residence [M Apartment House Commmercial ❑Traller Court ❑ j r Motel ❑Other ---=---------- ------- ---- Number.of living units..-.-/------- Number of bedroom s .. _..___Garbage Grinder ............ Lot Size ............................................ 1 Water Supply:;Public System and name ......................... Private ----------- -------------•---------- Character of soil to a depth of 3 feet: Sand'[ - Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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.[ 1.NEW INSTALLATION: (No septic,tarik or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I j Siae.--- -- -••-•-`-•--•- ---- ---•..._.__._... Liquid Depth ........................... i . Capacity •---------------_- Type -- .._ MdfL�rial Na. Compartments . ......... .r Distance to nearest: Well ....................................Foundation ... ........... Prop. Line ...................... LEACHING LINE [ j No. of Lines ------3 Length of each line.__-70_.:_._............ Total Length 'D' Box 4-------- Type Filter Material -4241.1 bepth Filter Material -----........... Distance to nearest: Well ....A.6.................. Foundation ....................:__. Property Line .................. ::.. (n SEEPAGE PIT [ j Depth .................... Diameter+ _.. Number .-_-----------------_---- Rock Filled Yes ❑ No ❑ i� Water Table Depth -----------------------------••---- ...Rock Size .......•.......................... Distance to nearest: Well ........................................Foundation ......_.._.._....... Prop. Line ................... :. I REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ............................. Septic Tank (Specify Requirements) --------•---------- .........................I................. ......................................... ._._..........._ Disposal Field (Specify Requirements) .......................... --- ----------------------- ---------------------------------------------- -•--•---- ..-- "" - -. ' (Draw existing,and regyired_addition on reverse side) i I hereby certify'that'f'have''prepared-this application and'lh�ie the work will be done in accordance with San Joaquin i 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 parson.in such manner as to become subject to Workman's Compensation laws of California." L Signed -.... ..•------ ------------ -------------=------•---••----.... Owner :..... T ............................. -----------------.................By ........... itle (if, other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 2��. •---...............•-----------•.............:............................. DATE _..._�'. '?�-•----._............. BUILDING PERMIT ISSUED .... _......-•----•-----......-----...................._•.......................DATE .............._..............---•------.... ADDITIONAL COMMENTS ...................................- --•-------------- ------------- -..................................................... L NW ----•-•.-•------------- ..................... -----------•..................................... - t t F Final Inspection by — ...... �.�- •--.... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1.'68 Rev- 5M 7I79 q u