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rvic �rrrt.t: va : 3 -0 APPLICATION FOR SANITATION PERMITr .................................. ........•----------••----- Permit No. ��.. 7 �� -. . .....................................I...... {Comple o in Triplicate) ............................................... This Permit Expires T Year From Date Issued 1 Date Issued . -�.:A``. Application Is hereby made to the San Joaquin Local Health District for a permit to:constrict and install the work herein described. This application Is made In Tomplia w unty Ordinan a No..549_and..existing-Rules and Regulationse JOB ADDRESS/LOCATIO ............... ., .... ..... CENSUS TRACT .......................... Owner's Name ..._ . ,�. ¢:. 1... . .. �`� ... .:e.... ��.......Phone .................................... Address ............_._.... .. �2.......... City ..... ..................................... -•-------------- .........-......... .. . -- r--- ---- . . ... . . 1 _ Contractor's Name .... . .�..., --- ...............License �: �-. Phone ... .. Installation will servo: Residence❑Apartment House Commercial Court ❑ Motel ❑Other.................... Number of living units:............ Number of bedrooms ._:........Garbage Grinder -tat Size..................................=.......... Water supply: Public System and name .......... "--............... ...................._........................................---•----•--ham❑ Character of%oil to a`depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ day Loom ❑ Hardpan❑ Adobe lil MaterlaIfj/as,type. . ........... ............ n\ { (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.] NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,! PACKAGE TREATMENT ( ] SEPTIC TANK f } Size.......:........................................ Liquid Depth .......................... Capacity -_---------_--- Type .................... Material...................... No. Compartments ...................... Distance to nearest: Well. ....................................Foundation ...................... Prop. Line ......................' :-EACHiNG 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 Water Table Depth ................................................Rock Sin ............. ................. Distance to nearest: Well ........................................Foundation .................... Prop. Line .................... REPAIR/ADDITION{Prev. Sanitation Permit# ............................................ Date .................................. Septic Tank (Specify Requirements) .............. .... a.. ..... .........: ._............ --- j ------ .. --• ..................................Fiel (S c�yRe uirants) . ...... .....--•..............................................:.............. .................................•---- ..........................................(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, 1 shall not employ any person In such manner as to became subject to WArk n' Compensation laws of California." 5:gnec' .. -------------r.`........................................ Owner r BY ... � YC.�.` : 7it1e . �!�.. . ..... ...... elfi?other than owner) FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY ----- v . -_ DATE .r�.'�"..:�_�,.:..........:.. . BUILDING PERMIT ISSUED -.. DATE-,::......................................... ADDITIONAL COMMENTS ..................... ----................ .-. . ............... ............. ... ............ ... ............. ...........-...-.;.................................. ' 1 .`"" i....... ......................' ......................:...........................�--.-------.-.................- ..........' .................. ...... _--.......... ... ............... Final Inspection by: '-:-. .. )..-. Date .. .... ....... ......--- EH 13 24 3-68 Rev. g44 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M v i _ i