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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- ----------------------------------------- -- ------ Permit No. _ `�'"_ _1_y (Complete in Triplicate) -- ------------------- ------------------------------ ----------- This Permit Expires 1 Year From Date Issued Date Issued 3'-`~ _ �_ Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: - JOB ADDRESS/1-0C TION . ��- �� CENSUS TRT -------------- 1: _�__f_�--------------- -- ----- ---------Phone --------�- -=z Owner's Name ---------C=e- -- �'- �� `-- -- ------------------------------------ --------- _ _ � c -------------- - City -------------------------------- -C -------------- --------� eContractor's Name -------- - ----. ---------- -------- ------ License Phon Installation = t will serve: Residence ❑ Apartment House,❑ ommercia) :❑Trailer Court ;❑ Motel ❑ Other Number of living units:----r------ 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❑ Clay ❑ Peat❑ 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, buildingsetc. must be plb'ced_.on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) � Liquid � — ________- TREATMENT SEPTIC TANK, Size- -°--�-�--- -- - - c------------------ �- [ No. Compartments -.�' ..._.Material-Capacity � Type Distance to nearest: Well ________c_6__0-----------_-------Foundation/---0-------------- Prop. Line r$----_______-----__ LEACHING LINE [ ] No, of Lines -------------- Length of each line--- _._____.______ Total length _ - ------------- 'D' Box ---,/.... Type Filter Material l f`� _Depth Filter Material - �- 1----------------------------- / Distance to nearest: Well ___, ------------ Foundation -/-a----- Property Line. —---------------- SEEPAGE PIT Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------__._ ........ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ________.--________________--.----1 Septic Tank (Specify Requirements) ---------------- ------------------------------------------------------------- -------------------------- Disposal Field (Specify Requirements) ---------------------------•-------------------------------------------------------------------------------------------------------- ----------------=->-- ------ ----------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) x 1 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 t as to become subject to Workman' ompensati.on laws of California." Signed Y Owner ---------- -------------- By ------ -------- ----- Title (If other than owner) FOR DEPARTMENT E ONLY APPLICATION ACCEPTED BY ----------- ----------------------------------- DATE _._ =IB-? BUILDING PERMIT ISSUED ------------------------------------------------- ------ ------------- --------DATE ------------------------------------------- ------- - ------ - ADDITIONALCOMMENTS ------------- -------------------- -- --------- --------------------------------------------------------- ---------------------------------- ------------------------------------------------------------------------------------------------------------------------ --------- /��- ----- Final Inspection by: ------------------------------------------------------------------------------------------ '-i!lJll__ Date --- _ ------- SAN JOAQUIN LOCAL HEALTH 1STRICT E. H. 9 1-'b8 Rev. 5M