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FOR OFFICE USE: += APPLICATION FOR SANITATION PERMIT ---------------------------------- -----1 Permit No. :. (Complete in Triplicate) .�- This Permit Expires l Year From Date issued Date Issued ----------------------------------------------------------- Application,-i's hel=eUy"ii ode' to the San':]oaquin Local Heafth-,District for a permit to construct and install'fhe work herein described; This-application is.. made in compliance "with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --- ----------------- = -- CENSUS TRACT -- Owner's Name ----l ,eRa- - i - -- _^' .-- --- - -------Phone _ " r ,� i Address . - -'- ------'- City Contractor's Name Phone _ " x , ' ---------- ---License Installation will serve: Residence DUApartment House❑_C-.omh)etrciah'�❑Trailer-Courtt[Di- Mote! Other ----------------- ------------------------ Number of living units:_._---- Number of bedrooms -_ .�`_ Garbage Grinder __ Lot Size _____________________________------------- (� Water Supply: Public System and`name -------------- ---------------------------------'----------'-----------------------------•---= Private Character of soil to a depth of 3 feet: Sand'[:] Silt❑ ;'Clay ❑4 'Peat 0 Sandy Loam 'T Clay Loam ❑ W Hardpan ❑ Adobe Lj Fill Material __I__:__---- if yes,type ____________________________ 7116, (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 tarik.or seepagd pit permitted if publicseweris available within 200 feet,l r PACKAGE TREATMENT { ] SEPTIC TANK Q ] Size-------------- ----------------Liquid Depth ___ -- __----- Capacity C Type __: _ Material,,.,,;�` ` ;No_ Compartments Distance to nearest: Wells ___ € _,_;_ ______________Foundation ! ' _;..'' Prop, Line .. ____- LEACHING LINE [ ] No. of Lines ----------- Length of each' line`_____ _____________ Total Length : D' Box ________ Type Filter Material � `'rte; t ' � � YP � --� -- -----------Depth Filter Material - ----------------_----- ------------- Distance nearest: Well E__--- __-_- ' _____- Foundatiori _____________---_________ Property Line ----------- ............. . k ' r SEEPAGE PIT [ ] Depth --------------- Diameter ------- -------- Number -=--i----------------------- -Rock Filled Yes [3 No Water Table Depth --------- '--------------------- Rock Size ----------------- -------------- r Distance;to nearest: Well ------------------'----------------------Foundation -------------- ---- Prop. Line ........ REPAIR/ADDITION�(Prev. Sanitation Permit# -------------- ---------------------- Date -----------------------.---------- -------------- 1 ~ Septic Tank (Specify Requirements) ---------- - - Drisposal Field (Specs Requirements) ----------------------------------------------------------`------------------------------- -------------r ---------'--- ----------------------------------------------- ____ ` w _- -�___ � 1 ...5 f -- Y co,,..�� (Draw existing and required addition on reverse side 4 I hereby certify that II have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, StateLaws and Rules and Regulations of the Son 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 Fpermit is 'issued, I shall not employ any person in such manner as.to become subiecf to Work ' nes Compensation laws of California." rr Signed - '�` ------------------------ Owner __ ---------------------------------------------------------- (If . --- ------ Title BY �; ------------------------------------ ----------------- (If other than ownerl -,VFOR D AItTME E ONL APPLICATION ACCEPTED BY ---- - -------=--- -------rr - ---- ------- = ------- ------------------ -- DATE ------ - ----"- --------- ------ BUILDING PERMIT; ISSUED ------------------------------------ ` ' - `.----- ------- --- = -, DATE ADDITIONAL COMMENTS ----------°--- ----- ` .. -- --------------- ----------- �`..` -- --------------------- * I `-- --------•---- ------------------------- ------------------------------------------------------------ Final Inspection ins ection b -- /------------- ------------------------- -----------Date _... ------ ----------- -------------------- SAW-JOAQUIN-C ---__ - SAW-JOAClUIN-C CAL�HEALTH DISTRICT . r E. H. 9 1-'68 Rev. 5M 14