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FOR OFFICE USE: t APPLICATION FOR SANITATION PERMIT,`, - (Complete in Triplicate) Permit No. ---------=-------------------- ------- -- -------------- r _.-----------_----.--. This Permit Expires,1 Year From Date Issued Date Issued l _`= P- = 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: JOB ADDRESS/LOCATION d 9f --- --- -.--- CENSUS TRACT -------------- ----------- '27/44-Owner's Name ]I -----•---------- -------Phone ------------ ® O - Address ---- ,-- _ Contractor's Name .-- -: ----. -- ---License #,�df..� -.Y- Phone ------------------------------ Installation will serve: Residence {PApartment House f[� Commercial :[]Trailer Court 0 Motel ❑Other f - - --=--------------- Number of living units:.___-_=Number of bedrooms .._.Garbage Grinder -- __ 11 Lot Size __ *c ` ---'�- - Water Supply: Public System and name -------------------------------•---- ------Private . Character of soil to a depth of 3 feet: Sand'o ilt❑ Clay_.❑ Peat E] Sandy Loam ❑ Clay Loam '[Ian Hard Adobe Hardpan ❑ Fill Ma#erial ------------ If yes, type ---------------------------- (Plot ------ ------ - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) F NEW INSTALLATION: 1No septic tank or seepage pit permitted if public sewer is available within 200 feet,} ,. PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth -------------- ......._-_-- Capacity� ----------------- Type -------------------- Material- ----- No. Compartments -----_•------..- Distance to nearest: Well ----------------------r_------------Foundation ---------------------.Prop. Line ---------------------- LEACHING LINE [ ] No. of ryLi. e- -------------------- --- Length of each line---------------------------- Total Length ----------------------------- 'D' Box __--------- Type Filter Material --------------------Depth Filter Material -------:------------------------------_------ s. . Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ---------.-----_-- SEEPAGE PIT [ ] Depth -.- -..---7-.----- Diameter --------------- Number ---------------------------- Rock Filled Yes ❑ No C Wate'r,,Table Depth.------------------------------------------------Rock Size -------------------------------- I Distance to nearest: We]I ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION{Prev. Sanitation Permit# --_-_-`:------------------------------------- Date __________________________________} Septic Tank (Specify Requirements) ----------------------•',:-.-•-------------------------------------------------------------------------- Disposal Field (Specify Requirements) �` -�----------------- -- = -------- 4 ---- -- -------- _6- ----�------ ------------�6------------------- ------------------------ x , . (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 si nature certifies the`followin : J 9 g "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 BY -------- f1-.-------- } Title ------------------- - (If other than owner] FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- DATE � � BUILDING PERMIT ISSUED ------------I------------------------------------------------------------------------------ ----- I------------------------------------------------------------------------------ -------------DATE ------------------------------------------ ADDITIONALCOMMENTS ----------- I--------------------------------------------------------------------------- ------------------------- --------------- --------------------------- ------------------ -----------------=----------------------------------------------------------------------------------------------------------------------------------------- -------------•-- ---------------- ---------------------- Final Inspection b -------.Date --or - --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M t