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FOR OFFICE USE: L APPLICATION FOR SANITATION PERMIT permit No. --------------------------'------- -------------- (Complete in Triplicate) ------------ --- Date Issued This Permit Expires 1 Year From Date Issued ocal Health District for a permit to construct and install the work herein Application is hereby made to the San Joaquin l de in compliance with County Ordinance No. 549 and existing Rules and Regulations: described. This application is ma --------CENSUS TRACT -------------- ------ --Phone 1�-r11 - ,--<^ ri Owner's ------ -------- ----- .-._�-�--�------_`-_�--�f JOB ADDRESS/LOCATION --- city.- - _ t" -" p ------ one Contractor's Name -._ .f -_,--. 4- 'f_�`e-__- :LicenseInstallation will will serve: Residence V Apartment House f❑ Commercial ❑Trailer Court i[] Motel ❑Other --------------------------------- Number of living units:-/______ Number of bedrooms ____�_ ---_.Garbage Grinder _---__----.- Lot Size Are-t40f-e-.-------------- Private Water Supply: Public System and name ---------------------------------•- - _ Character of soil to a depth of 3 feet: - Sand'❑ Silt❑ —Clay ❑ -Peat❑ Sandy Loam �` Clay Loam El y e ---------- ----------------- Hardpan ❑ Adobe ❑ Fill Material _--_-_-_--- if est type c must be laced on reverse side.} et . P � {Plot plan, showing size of lot, location of system in relation to wells, buildings, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK:[ ] Size---- --- ----------- ------------------ Liquid Depth ---------------- i Capacity -------------------- Type -------------------- aterial ------------------ -- No. Compartments --------------------- Distance to nearest: Well ---------------------- -------- ---Foundation ---- ----------------- Prop. Cine ------------•--------- LEACHING UNE [ ] No. of Lines ---------------------- g ' Length of ach line---------------------- ---- Total Length ---------------------------- 'b' Box _-- -------- Type Filter Materia ----- --------------Depth Filter aterial ------------- ----------- i - Foundation ---------- ----- Property Line ---------•-------------- pistance to nearest: We _-------------------- SEEPAGE PIT [ ] Depth --- Diameter Rock Filled Yes No Number ❑ ' r Water Table Depth Rock Size ___ _.-r-------------------- ---Foundation -------------------- Prop. Line ------------------ Distance to nearest: Well ---------------------- I f REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------------------- Date ----------- ------------•-------- } Septic Tank (Specify Requirements) -------- ------------------------------- ------ --------------- --------------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------- ----- --- -- - ---------------- /�Vd -tea ��- �� -- - • -------------------- _ --- -- - ------------ -- (Dra existing d required addition on reverse-s--i-d--e--)- i e) 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. Horne 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 as to become subject to Work n's Compensation laws of California." Signed ---.. Owner --- --- ----------- ---- By ------------------- �V7 8e ------------------ ----------- ------------------- ------------------- Title ---------_------ ----------------------------- (If other than owner) FOR DEPARTMENT USE,OrNLY r a.. int DATE 'l _�---------------------- APPLICATION ACCEPTED BY ------------------------------ ------------ ---- ------ = BUILDING PERMIT ISSUED --------------------------- !- DATE - ------------------------------------ ADDITIONAL COMMENTS -------------------------------------------------------------------- -------- ---------------------- - --------------------------------------- ------------- ------------- --------- ------------------- --- --- ---- --------------- -- �_�� ---------------------- ---------- Final Inspection b - - - - -----.Date ------- ---- ----- -f-- ----- -------- ---- SAN JOAQUIN LOCAL HEALTH RICT G F_ H. 9 1-'68 Rev. 5M