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FOR OFFICE USE: '04 APPLICATION FOR .SANITATION PERMIT ------------------------------------------------------ Permit No. . J� (Complete in Triplicate) Date Issued _ ----------- ---------------- -------------------------- This Permit Expires 1 Year From Date Issued 1 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 and existing Rules and Regulations: s -- - � �✓ ----..�CE'N--SUS TRACT ------ --- ----------- JOB ADDRESS/LOCATION h -- -------------- -- ------ _ --------------- Phone T Owner's Name . .....cG � --- --------------------------------------------------- City ---------------------- ------------------------------------------------------ Address Contractor's Name l S ---------------------- ;-------.License # ---- Phone ------------------------------ Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court '•❑ Motel p-C her -------------------------------------------- Number of living units.-_/o---- N umber of bedrooms fro-------Garbage Grinder Lot Size _. ----- `----------------- ----- Water Supply: Public System and name ------- --------------------------- -----------------------------------------------------------------------Private I9.. Character of soil to a depth of 3 feet: Sand E] Silt F1 Clay ❑ Peat El Sandy Loam ❑ Clay Loam E] Hardpan ❑ 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 sic NEW INSTALLATION: (No septie,tarik or seepage pit permitted if public sewer is available within 200 feet,j PACKAGE TREATMENT [ SEPTIC TANK'[ I Size-------------------------------------- - ----- Liquid Depth -------------------------- Capacity -------------- --- Type -------------------- Material--------------------.- No. Compartments - ---- i Distance to nearest: Well ------------------------------------Foundation --___--___-_--- ----- Prop. Line ----------:----------- LEACHING LINE [ ) No. of .Lines ----- -- ---------------- Length of each line--------------- ------ Total Length ---------------------------- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ------------------------------------------•- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line. -------------------=---. SEEPAGE PIT Depth = ___ Diameter _-_____-----.__ Number ---_----------------------- Rock Filled Yes ❑ No U 1- Water Water Table Depth ------------------------------------------------ Rock Size -------------------- ----------- l Distance to nearest: Well --------------------------------------- Foundation -------------------- Prop. Line -•--------_---------- i I, "I I REPAIR/ADDITION(Prev. Sanitatid k Permit# -------------------------------------------- Date --'-------------------------------} Septic Tank (Specify Requirements) -------- ------------------ ; - ic Disposal Field (Specify Requirements) w �- '6 -------------------=---------------------------------------------- - -------------------------------------------------------- --------------- --------- ------------------------------------ ---- ---------- �__ __ a" [Drew existing and required addition on reverse side) i 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, 1 shall not employ any person in such manner as to becom su ject to Workman's Compensation laws of California." Signed _._ • --- Owner By ------ ------------------- Title ------------------------------ - ---------------..--------- ---------- - (if other than owner) ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _._`ad'-- -- ---------------------------------------- ------.------ DATE --- -- F BUILDING PERMIT ISSUED•------.-`_` -------------------------------- -----DATE -------------------------------- ------- ADDITIONAL C MMENTS ----- -------- ---- r"L1 t- - =� --4" ' --P - 7(_ a.r r r 6Lfnz ; = _. - ---- ---------------- - -------------- -- -- -- ---- -- - -----'�'_`-_ - ----- - - `~ -- - - --- -__.- - -- ------------- ------- - --------------- ------- -- ------------------- - i-s-- ----- - ----f - r' Final Inspection by: ----- �. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M