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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -"---- �. --------------------------'------------ ------- (complete in Triplicate) Permit No. p Date Issued -------------------------------------------------- - ---- This Permit Expires 1 Year From Date issue e work rein Application is hereby made to the San Joaquin Local with County ealth trict Ordinarnce No. 549 and ex sti g Rulesa permit to construct and talnd hRegulations.. described. This application is made in compliance JOB ADDRESS/LOCATION ---- -------------- --------------------------------------------------------- -- CENSUS TRACT -- Phone ------ 0wner's Name - �/�--- ------ —41- --------------- � ------------------- ------------ City ----�� ------------------------------------------------------------------------------- --- •----- J�- u'= - - 6 L` License # ------ - _ ` _ Phone b _` _ _S3 Contractor's Name ---_- " -------_. Installation will serve. Residence fj Apartment House❑ Commercial ❑Trailer Court '❑ Motel ❑Other ----------------------------------- -------- /` ��r p -----Garbage Grinder .---/------ Lot Size/7-Off __-?;-/-----"--- Number of living units:_ _.�____ Number of bedrooms __� - �.� Water Supply: Public System and name ---------------------------- ------ ------- ------------------------•---------------------------- - Private Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay E] Peat E] Sandy Loam ❑ Clay Loam XL Hardpan F-1Adobe❑ Fill Material ------------ If yes,type ---------------------------- (Plot plan, showing size z of lot location of system in relation to wells, buildings, etc. must be placed on reverse side.) �J � NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) I SEPTIC Size__J�-d0 -------- - Liquid Depth -------------------------- O PACKAGE TREATMENT { ] �?(J Capacity --------------------- Type ------------------- Material---------- --------- ok Compartments g Distance to nearest: Well _.___1aQ---------------------Foundation -119-- ---------- Prop. Line -------------=------ LEACHING LINE [ I No. of Lines ------------------------ Length of each line---------------------------- Total Length ------------------------ �._ ,D'Box�- ' TYPe FiFilter Material __-- _--- - Depfi ter AAatenal'"-------------------------------------------- '-'Box --------- ---- ---- Foundation ------------------------ Property Line --------------- ------ Distance tonearest: WeI1 ------------------- [ ��jj r D:�_ d-- Number /------------ Rock Filled Yes No i❑ I SEEPAGE PIT [ ] Depth ._7.A------ a Water Table Depth ---- -----12a-f-------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________ _ Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -.----------- ------------------------------ Date ---------------------------•------) Septic Tank (Specify Requirements) ------------- --- ---------------------------------------- - - - r Disposal Field (Specify Requirements) -- ------------------------------------------ t ----- -------- ------- --- ---- ---- - - ------ ----------------------------------- ---------------------------------------------------------- [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: f permit is issued, I shall not employ any person in such manner "I certify chat in the performance of the work for which this as to become subject to Workman's Compensation laws of California." Signed --------------------- ----------------------------------------- Owner - - --------------------- BY r ------ Title -------------------------------------- ------------- ----- ------------ - ------------------------------------ ------------------------ ------------------- {if other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - yh�! - DATE ' _ --- ---------- ----- ---- __ __ --- -DATE - ---- -------- --------- -------- ----- BUILDING PERMIT ISSUED--------------------- - ---------- ------ ----------- --- - - - - - ADDITIONAL COMMENTS ---------------- --------------------- ----- - --------------------------------- _ ------------------------------- ----- �'- '------------------ - -- --------- ------------------------------------ ------Date ----- --- ----- -- -- -Final Inspection b -- - - - --- --- k SAN JOAQUIN LOCAL HEALT ISTRICT Y E. H. 9 1-'68 Rev. 5M.