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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 6"• 93 `` 3 X ------------- --`--. ------------ ---------------- -------------- (Complete in Triplicate) Permit No- ---------=-- --------------------------------------------- Date Issued �'� � • �•[�t-+�� This Permit Expires ] Year From Date Issued°<---- ----- -=------------==------------ p 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 exis ng Rules and gulations. PN- JOB ADDRESS/LOCA ION .-��_ -- �`�--f �l1 = '4"`" CENSUS TRACT ___----------------____ _ Owner's Name - = Phone —----- -- ------------- Address -'- �' x ✓ ------ --•- ------------cit lJ r-d ` _-_ License # 1� �� Phone Contractor's Name ----____-- 'Z' --� " Installation will serve: Residence C9 XApartment House❑ Commercial :ElTrailer Court '❑ Motel ❑ Other ------------------------------------------•- Number of living units:------ ____ Number of bedrooms ---- ------Garbage Grinder ------------ lot Size ----------------------- - Water Supply: Public System and name ------------------ --------------7----------------------------------- --- - --Private � r Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ Peat❑ Sandy Loam Clay Loam ❑ 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 side.) W i' NEW INSTALLATION: (No septic tank or seep ge pit permitted if public sewer is available within 200 feet,) f Liquid Depth --_____ ._ -__ PACKAGE TREATMENT { ] SEPTIC TANK'[ 5ize__y,�-- �1'__�>--------------------w----:_ - q p - - -------"""- h Zrs U e Material No. Compartments.4K-'-----..."- --- '-�- Capacity -------------- TYP i Distance to nearest: Well ---------- v ..._.-___Foundation ----!_fl------------- Prop. Line ----_____-____.,_____- LEACHING LINE [,T�_'No. of.Lines J--------------- „-.T._Lendth of'each line-------iq_r�.............. Total Length _-------.------- 'D' Box ---- Type Filter Material ____!5-2------Depth Filter Material ___ _f _______________----------•------ r- --- Foundation -----lo- ------------ Property Line _S-- -..--- - Distance to nearest: Well _______ _____ __ - - SEEPAGE PIT [ ] Depth __ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No J❑ Water Table Depth --- -------------------------- -------- -` -------------Rock Size ------ ------------------------- Distance to nearest: Well ----------------------------------------Foundation ------------------.- Prop. Line ---------_-------•_-•- REPAIR./ADDITION(Prey. Sanitation Permit# -------------------------------------------- Date _---------------------------------} Septic Tank (Specify Requirements) ------ ------------------ ------------------------------------- ----------------------- 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: " permit is issued, I shall not employ any person in such manner I certify that in the performance of the work for which this as to beco s Sect to Workman's Compensation laws of California." Signed ----- ------------------------------------- Owner BY ------- --- -- -------- Title --- --- --------------- -------------------- (If o - -----ther than owner) EOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- ------------------- - ---------------------------------------- - DATE _ __-. .Q BUILDING PERMIT ISSUED --- ---- --------- --------------------- -----DATE -------------•----------------------------- ADDITIONAL COMMENTS --------------------------- ------------------------------- ------------- ------------------------------------- - ---------------------------------- Fina{ Inspection bY: ----- - - -------------------- - --------------------------------------- ------------------- ------------------ - - - y ---- - ------Date Qf SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M