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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ---------------------------------------------------------- ________ 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 install the work herein described. This application is mdde in compliance with County Ordinance,No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION /_ - /1----- -------- --- -----CENSUS TRACT __S �- ------------- Owner's Name �_d ------ ------------ ---- --Phone -------------------- Add ress ------ " City ------------------------ Contractor's Name ___ _ _ " I License #/"- _ Phone Installation will serve: Residence ❑ Apartment House-E] Commercial :❑Trailer Court ❑ E I Motel ❑Other Number of living units:_-_ ____ Number of bedrooms -_-----Garbage Grinder .__ Loi Size _�4 --------------------- Water Supply: Public System and name ---________-____ __ _____ _____Private Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam :R_ . VA s ; Hardpan Adobe ❑ Fill Material ------------ If yes, type --------------------------- (Plot plan, 4showing 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,) i PACKAGE TREATMENT [ ] SEPTIC TANK![ 7 Size------------------------------ ----------------- Liquid Depth ---------------._.-------- Capacity Type Material--------- ------------ No. Compartments ------------ Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -------------------_- LEACHING LINE [ ] No. of Lines _______________________ Length of each line---------------------------- Total Length 'D' Sox --------- Type Filter Material ____________________Depth Filter Material ------_______ Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line __--_________ SEEPAGE PIT [ ] Depth �_._. p __________ Diameter ---------------. Number __ Rock Filled Yes '❑ No i❑ Water Table Depth ------------------------------------------------Rock Size Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line ------------------ REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------___----__ Date Septic Tank (Specify Requirements) --------____-----__ Disposal Field (Speci{y Requirements) ��- - -��-----------.-----------------------..__,•.------------------------•-- --' ----------------- ------------------------------ ------------------------------------------------------------ ----------- - - --- --------------------------------------------t--------- -------------- - - - ---------------------------------------------------- i (Draw existing and required addition on reverse side) _ I hereby certify that I have prepared this application and than the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Mules 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 mannef as'to become subject to Workman's Compensation laws of California." Signed > ------------ ------- Owner -- -----------�_la ---BYF------------- ------------- ------------- -Title - ---- � {If oth an owne } 3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _._ -_-_-.-_-__-___-_---------------------_- --- =- ------------------------------------------------- - --------------------------------------------------------------- r BUILDING PERMIT ISSUED ---- --- -------------------------------- - D ATE --------------- - --------------------------- -------DATEADDITIONAL COMMENTS --------- ---------------------------- � ------------------------------------------------- ----------------------------------------------------- -------------------=----------------------- ---------------- -------- ection b = P Y ---------------------------------------------- -----------Date - ._ _��-� --- Final Ins SAN JOAQU,IN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.