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FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT Permit No. ..� Y .•- -- ---'----------- .................. (Complete in Triplicate .......................... .------- --.--.- 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. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: _ ----._CENSUS TRACT ........:................. JOB ADDRESS/LOC - . _� � --•-- ---- --------- Phone ................... Owner's Name .._ _. _ City - ------------- ---------------- . . Addressi a :..._._.license #/Z� -y 3 khone ------- -----•-- I Contractor's Name -- ----- Installation will serve: Residen a Apartment House Commercial ❑Trailer Court :F] Motel ❑ Other . - Number of living units:...... Number-of bedrooms ............Garbage Grinder .. ........ Lot Size teiz}'- -f... Private Water Supply: Public System and name _ ----------- -----------------'----- "--`--"- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam / Clay Loam ❑ Hardpan ❑ Adobe n 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 ] PACKAGE TREATMENT { ] SEPTIC TANK: Size... --- -----------..-------------------- Liquid Depth ......... .... w Capacity - -- .---- --•-- Type -- -•-------- -•--- Material ........... ....... No. Compartments ---- ___----------.--- .- -K - ----- -----------Foundation ------ .... Prop. Line Distance to nearest: Well _______- -- � Length of each line ..____-_ .... Total Length ,........................... LEACHING LINE t ] No. of Lines --- ---- • � �- ._,Depth Filter Material ----------------------------------------- 'D' Box ------ ... Type Filter Material ________________ P Distance to nearest: Well ._-.__...--------------- Foundation ..----- _-------- -. Property Line .....--•.-------•------- SEEPAGE PIT [ j Depth _... Diameter ................ Numbe- -. .........-.. ........... Rock Filled Yes ❑ No i❑ i -•---Rock Size ..._ ----- --- ----- - Water Table Depth -----.----.----------••••-•----••. fo Distance to nearest: Well ---------------------..--•-----. ---.... Foundation -------.. Prop. Line ----- ----------•---- REPAIR/ADDITION(Prev. Sanitation Permit# ---.• - --- ---- ..................... Date -------------------------- ------- Septic Tank (Specify Requirements) _________ ------------------- - Disposal Field ISP fY quit e '� -------••- ......•. -- v? ----------- ------------------- --------- ..........------- -------------••--.-.................. (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 Ilcen- 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 _..... _ _ ..__ - ---- .. ow --� BY -------------- - •d"'- Title -2� ✓L -- - (If other than owner) FOR DEPARTMENT USE ONLY ( c:._.. ... � . . DATE 7 ._r...-"_T ......... APPLICATION ACCEPTED BY __ �� _ .. BUILDING PERMIT ISSUED ----- --_ -----------------------...---------._............ .DATE ........... ADDITIONAL COMMENTS ----- - ---- ......................... -•----.....--••--•---•-......-••• ... ._..•..... .- ..... Date .I l I Final Inspection SAN JOAQUIN LOCAL HEALTH DISTRICT . F H 9 1-'68 Rev, SM