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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------- --- --------- p p Permit No. __7. .6 � (Complete in Triplicate) i - --------------------------------------------------------- j This Permit`Expires 1 Year From Date Issued Date Issued ...�.=.13:_?.2-�" ------- ------------- ----------------------------------- 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: �F 5 � /J -------------CENSUS TRACT ---- - -------•------- '- JOB ADDRESS/LOC ION .------- __-- :- -. ------,- _�_-_- _------ _- Owner's Name -- - ----- -------, Phone AddressIl ._ CitY "'. Contractor's Name ------tom = = ---License # _� � _ Phone ----------------------------f Installation will serve: Reside e ❑Apartment House❑ Comme al :❑Trailer Court E3 Mote! Other Number of livingunits------------- Number of bedrooms S Garbage Grinder Lot Size -------•---•••• -- Water Supply: Public System and name ---------------------=------------ ------------------------------------------------------ -_--_--------Private [X Character of soil to a depth of 3 feet: Sand'E] Silt FE]❑ Peat❑ Sandy Loam ° Clay Loam E] Hardpan ❑ Adobe.❑ Fill Material ------------ If yes,type --_--__-._---------------- r I {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 pub�cy see�wer`i"s available within 200 feet,j / PACKAGE TREATMENT [ ] SEPTIC TANK ji�J Size--_�f/x-_11--1-�XS-----'-` -- Liquid Depth ---- .---_-_-_--,-- Capacity�rr�� _ «<___ _ Type -Zs_ __ Material -�.—____ No. Compartments _-- ._...__._.f- Qistance to nearest: Well ________-_ Foundation _-__f-__l--_-_--_- Pro Line -------�___-__-._:_ LEACHING LINE [ J� No. of Lines ------ 'Length of each line____ $_-- '._�._-.___,Total Length _--lt_ta.-�....__..__,� 'D' Box ___1__._ Type Filter Material ------ _9------Depth Filter Material _ _ Distance to nearest: Well --------'0--------- Foundation ------- _.-_---_--- Property Line. __.S--�..__.___._i_l� SEEPAGEPIT [ ] Depth -------------------- Diameter _-------_--_-_-- Number ----------------------------- Rock Filled Yes ❑ No IWater Table Depth - - ------------------------------ -----Rock Size ---------'------------------•---.Distance to nearest: Well ----- --------------------------------Foundation --------...__.___._. Prop. Line ........_...._..._..REPAIR/ADDITION(Prey. Sanitation PermitF# -------- ---- ------------------------------ Date -----------.-__---------------_]Septic Tank (Specify Requirements) ---------------------------------------------------- ------------Disposal Field (Specify Requirements) ------------- --------------------------------- ------ ----------------------------------------------------------------------- -------------------------------------- ----------------------- ---------------------------- ------------------------------------------------- --------------------------------------------------------------------------- ------------------------------ - - -- ------ --------------------------------------- --------------------------------------- F (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 licenL 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 m n's Compensation laws of California." Signed ---_----------------- - ____, - - ---------- Owner -- - --------- By ----------- ---------------------- ----------� -------- Title ------ -------------------------------- (If other than owner] FOR DEPARTMENT USE ONLY APPLICATION_ACCEPTED_BY: . ._ _'�_ :' : ------ = ------------------ DATE ----44._ -- 4�4.`1- ------------- _.� : BUILDING PERMIT ISSUED --------t �UA ..--_--_ ¢--------------- DATE ADDITIONAL COMMENTS ------------------------------- ---------- - _ r r ` = --------------------------------- ---- - - - - --------- -- ----- ^ o--- Final Inspection by ------------------------------------•-------•-------------- ------------------------Date � '. SAN JOAQUIN LOCAL HEALTH DISTRICT r E. H. 9 1-'68 Rev. 5M