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FOR OFFICE USE: �.'i�0 R APPLICATION FOR SANITATION,PERMIT / r (Complete in Triplicate) Permit ________ 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 in the wok herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCATION . Owner's Name ---------------------------------------------------------Phone Address --------- Contractor's Name__ --- -•- - city Cit y --------- =--tea-- _ License Phone Installation will server Residence ]Apartment House-[D Commercial:❑Trailer Court ❑-' € ;� Motel ❑ Other -----------p�T3=�`�`--c•� _ Number of living units:- �_____ Number of bedrooms __ Garbage-Grinder-____,.-...___.Lot.Size Water Supply: Public System and indme ______________________ Private --------__ --------------- -----------------------•-------- ------------- Character of soil to a depth of 3 feet: Sand' Silt Cla ❑ ❑ y .❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if pybiic sewer is available within 200 feet,) W PACKAGE TREATMENTJ r I � SEPTIC TANK'[�1 Size� �`_�---2-'--- - ----------------- Liquid Depth ---- ---------- ' No. CompartmentsCapacity -� i�"�jTYe Material - --.------•----- r "Distance to nearest: Well -----�----------------------Foundation -`--------- Prop. Line .-5----.----,---••- LEACHING LINE '_ � 1 - r [ ] No. of Lines ----- ---- Length of each line---- ©O--------------- Total Length 1.0 ------ + Distance to nearest: Filler Material ______ __ _____Depth Filter Material ______dy:_°�_________ D' Box __-- _--- i ----- Foundation ---------J-§?---------- Property Line - -Z�0 .0 SEEPAGE PIT [ Depth 'i Diameter _d------_- --_n-- Number ------- -------- -- -------- Rock Filled Yes Water Table Depth -------------------------76 Rock Size -x I -------------•---- Distance to nearest. Well ---------------L_ o-°------ ------Foundation --------P-�-` ---- Prop. Line ----`C........------ REPAIR/ADDITION(Prev. Sanitationj Permit# --------_----------------------------------- Date ---------------------------------- Septic Tank (Specify Requirements) I -------------------------------------------------------------------- Disposal Field (Specify Requirements) ------------------------------------------- ------------ ________ _----------- -- -------- --------------- ------------- --------------- o, - ------------------------------------------- (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 i as to become su orkman's Compensation laws of California." Signed - --------------- l Owner BY a•---- ` ------ Titled (I other than owned I TOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------------------------- DATE BUILDING PERMIT ISSUED ------ - -------------------------------------------------- ---------------------------------DATE ` ADDITIONAL COMMENTS --------------------------- --- 11 ------------------ ------------------------------- --------------------------------------------------------------------------- --- ------------------------------------------------ ------------------------ --- --- t , -------------- -------------------------------------------------------------------------------------- -- - I=inal Inspection by: ___ _ - ------ ----- � ------------------------ DateD SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M, i