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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 'F Permit No: ------------------------------ F( (Complete in Triplicate) ---------------------------- I.F i Date Issued t This Permit Expires 1 Year From Date Issued ll the work herein t d i Application is hereby made to the.San Joaquin Local Health District fora permit to construct and 9 ce with County Ordinance No. 549 and existing Rules and Regulations: described. This application is made in complian it 9 -, _ +-_!-"""-````} ENSIJS TRACT JOB ADDRESS/LOCAT ON -_---- . - --------- Owner's Name _ ------ Phone _____-- .r�C�i - ----- -- City _ Address ------------ � ------- - ---------�;----------------------- -----------•---- �'� - - - - - - -` .License # _-� Phone - ----------- ---------- Contractor's Name - ---- — i ---------- ---- ----- Installation will serve: Residence EfApartment House❑ Commercial :❑Trailer Court il] Motel ❑ Other - ------- ---------------=------------------ ] --- ----------- - Number of living units:------�_---- Number of bedrooms _ _ -_--Garbage Grinder ___-__--_-_ Lot Size ._ _--________---._- ---- _ Water Supply: Public System and name ____________--------•---------•--------- --------- -------------------------------- -----------Private Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay F1 . Peat❑ Sandy Loam ['J�C1ay,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.) NEW INSTALLATION: (No septic tank or seep a pit permitted if public`ewer available within 200 feet,) 1 -------- Liquid Depth �-- ------------ . PACKAGE TREATMENT [ ] SEPTIC TANK_{!'�.�..-- SizeL/, -1 - -- --`s q p \ i Capacity[--] -�'- ---- Type No. Com artments _ __---- -_-- Material -- p , r Foundation 1-�------------- Prop. Line --- N Distance :to nearest: Well _______ d-_______---- U 0 LEACHING LINE [ No. of Lines -------j------------ Length of each line--___-$D------------- Total Length ,----------.--------•------- D' Box -!__-' - TYpe Filter Material ----5 !Z- Depth Filter Material ----el-----------------------�•.-----:--- I r m ---- b_`--------- Foundation ------1-n------------- Property Line .__d_•---•-----•-• -- Distance to nearest Well r= SEEPAGE PIT [ ] Depth ----- ---=--- '_ -Diameter ---------------- Number ------- -----m--Rock-Filled Yes ❑ No 0 Water Table Depth ----------- . - --- Rock Size -------------------------------- ----- Distance to nearest: Well -------------------------------------:;Date -------------,------"-Foundation __ .__.--"__----:----------)•---- Prap. Line _..------- ----,----- k REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------- ---------------- - Septic Tank {Specify Requirements] --------- ------------------------=---------------------------------------------- ------------------------- -- _IT`--- - 1--__ 1 e i Disposal Field (Specify Requiremnts) ------------------------- ---------------------- -- --------------------------------------------- - = ------------------------ -------- --------------- -------------------- ---- I ----- ------------------ -------------------------- - g„ - - ----------- - - -=-------------------------------- ` I hereby certify that I have prepared this a plication required addition on reverse side) --- -------------------------------------------------------- --------------- -------- {Draw exis#in a y p p 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 Stealth District. Home owner or licen- sed agents signature certifies the following: "I certify that in a performance of the work for which this permit is issued, I shall not employ any person in such manner as to becom ub'ec to Work"' 's Compensation laws of California." Owner �~ Signed ---- -- -------- -- - --- -•- ..�. ----- - Title .._ - ------------ --------- -------------- (If other than owner) I FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------- DATE . - -L�1 BUILDING PERMIT ISSUED --------t------------------ --------------=------------- DATE ADDITIONAL COMMENTS ------ 11-------- -----�----- ------------ ------------ ---------- ---------- - -- ----------------------------- ------------------------------------------ ----- -- !` ------------ ------------------------ - - _ --------------------- ------------------------------- ----------. --- -- - - Final Inspection by: _._- -Date _c ---- -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M