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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate)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 an existing Rules and Regulations: JOB ADDRESS/LOCATION . -`- - 5 TRACT _ Phone6_.�- Owner's Name �l ---------------------- --- --- -- ---- ------ Address - ---------------------- -- City ------------------------------------ --------------------------------------- Contractor's Name -------------! __-- _-- -- ---------------License #/ -------- Phone Installation will serve: Res idencet�Apartment House❑ Commercial ❑Trailer Court l❑ Motel ❑ Other ------------------------------------------- Number of living units:--_/----- Number of bedrooms ---Y----Garbage Grinder -7�-- Lot Size ---------________________________________ Water Supply: Public System and name ----------------------------------- ------------------ -------------------------------------------------------Private Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe . Fill Material ------------ I f"Y esjtype_-------------------------- (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;[ ] Size------------------------------------------------ Liquid Depth ----ef--------------.----- V Compartments -,- -------------Ca ------ Capacity --------------- Type -------------------- Material---------------- No, ' Distance to nearest: Well ------------------------------------Fouadation.v_--___s_---_`----- Prop. Line ----,€1 -`:__-.---- LEACHING LINE [ No. of Lines ----------------------- Length of each.--1`ine-4.-------------------- --- Total Length ------•---- - ' - ��d D' B x _------.�--- Type Filter Material------------------Depth Fi ter Material) __-.______ =-'--•- I Distance to-nearest: Well ------- Foundation_ ________ ___ __.__ Property Line --------------- SEEPAGE,PIT �{ ]f �� Depth ------------------1 Diameter ---____-_-_-_-- Number _ _ �__ -------- Rock Filled Yes Q No S •.� Water Table Depth -------------------- --- -`-----__-------_RocliSixe ----------------- ----- ------- y_Distarcce.to nearest:` Well _.___--k----_--------------------------Foundation Prop. Line ------..._--------_--- . REPAIR/ADDITION(Prev. Sanitation Per mit# ----------.-_ -- --------- Date I--------------- -------- l Septic Tank (Specify Requirements) --- -----"-- I-��----- -- �� r -C ---------- ----- Disposal Field (Specify Reuirements) rA---,----'� - -----------�� -- ----- --- -- --- ------------ --- --- r 4 -� - ----------------------------------------------- ------ -------------------------------- ' (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." t I I Signed ------- ----------------------- .... -- ; --------------. Owner4m r ' ' ------------------ Title ------------ - � l--------------------------------------- (If other th owner) I I FOR .DEPARTMENT USE ONLY / APPLICATION ACCEPTED-B ----- ----- ------------------DATE.---��`='36---6- -------------- BUILDING PERMIT ISSUED ---_-__.-_-- DATE ------------ ------------------------------- ADDITIONAL COMMENTS __�- - �-- _ ,_ ---s_-�r1�---'-.--------- -- --------------------- ------=--------------------------• ------------ r > --------------- t - _0_ --- -------------- - -------- - ------------ --- --------------------------------------------- C� Final Inspection by: __---- --------------------------Date -_---_-� �-w - - ----- -- - ----------------- --- -------y-------- - - ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M