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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT D ------ -- -- Permit No. (Complete in Triplicate) 10XV ----------------------------- 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 made in compliance with County Ordinance No. 549 a d existing Rules and Regulations: JOB ADDRESS/LOCATi N 11-9----------&!----��'.�- �--CENSUS TRACT r Owner's Name `----.14-t-----� — ---------------------------------- -Phone ----- r---Address -------------- ------------- ------------ ------------ ------------LicenseContractor's Name ------------ Q --. -_-- - hone _ -- J �L2-_ � Installation will serve: Residence partment House❑ Commercial.❑Trailer Court ',❑ Motel ❑Other -------------------------------------------- Number of living units:----- Number of oo s�__ Garbage Grinder - _(�__ Lot Size __._______ __ --______.______________ Water Supply: Public System and name ____- �___t_ `_.___ -__ _________________ _ _________Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam "❑ ' Hardpan E] 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 public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK (� Si e______ --- _. �i______--_---- Liquid Depth -_�Z.�.______,... Capacity _L-- --- -------- Type ne_�1'Material--- _J Crlc lo"Compartments Z_____.__._.__:__-_ Distance to near t: Well ----_____-_`-_ ___________Foundation__-�_------ Prop. Line ---- ------ LEACHING LINE No. of Lines --------- ----- Length, of each line.._.__ ___ -r Total Length ........ _ � rr -- --------- 'D' Box _��_ Type Filter Material �1�---rl_------D.Ft7i Filter Material ___/ 10----------------------___._..____._ Distance to nearest: Well ____--^"_�____ Foundation __ - -_-_------- Property Line / Rock/Filled Yes [r No ❑ SEEPAGE PIT [� Depth �.�_I------- Diameter 2� ? -�_ Number --- L___------__. /l / Water Table,Depth ------------46_(__1-------- ------------Rock Size l_ P_X�_`�_ ___________ / Distance to nearest: Well --------------------—-----------------F.oundation -/Q_.._____ Prop. Line ................... REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- ---------------------- Date __________________________________} p Septic Tank (Specify Requirements} -------- ----------------------- ----------------------=----------z•-----------------•---------- Disposal Field {Specify Requirements) --------------- ----------------=------------------------------- --------------- ------------- -------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------=--------------------------------------------------------------------------------------------- (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 as to become subject to Workman's Compensation laws of California." Signed ------------------ ----- Owner BY ---------------------------------- --- � ---- ------- - --------Title ------ - - (If other th ner FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-__ a -------- --- --------- ----------•----------------------------------------- DATE ---- ------------------- -BUILDING --- --- -BUILDING PERMIT ISSUED ------------------------------------ ---------------------------- -------------------------------------DATE ADDITIONAL COMMENTS (------------------------- ----------- ------------------------------------------------------------- ----------------------------------------------- ---------------------------------------------------------------- O ----- Final Inspection by: - - -- ------------------------------------------------------------------------- -------Date - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M