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FOR OFFICE USE. APPLICATION FOR SANITATION. PERMIT pp ------------------------------ ----------- (Complete in Triplicate) Permit No. --------------------------------- ------- ------- This Permit Expires 1 Year From Date Issued Date Issued _-__ ____1_ ___]_1 Application is hereby made to the San Joaquin Local Health District for per to construct and install the work herein described. This application is made in c mplian with County Ordinance No. 549 and existing Rules and Regulations: 0.s© _ JOB ADDRESS/LO TION ---------------------------- - ��"" ------- P ----- CENSUS TRACT Owner's Name _. - Phone _ 5- ,Gp ----------- - - ------------------ Address _. .. -----= ------- - City Contractor's Name .______- ce ; ____ ___________r�l1' __ _.License # Phone ----------------- - � Installation will serve: Residence ❑ Apartment use-❑rComm oiler Court 0i > Motel ❑ Other -- - --- --------- ----- s Number of living units_____________ Number of bedrooms ---------.-.Garbage Grinder 4----------- Lot Size .C -��-U-io--------- 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 ------------ 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK SizFa _ �___________________ Liquid Depth ____ --- _,.,-. Capacity' _ _: _„__ Type - Material________ No. Compartments ______________ ------ Distance.to nearest: Wel) -------_____________________Foundation ------ -------- Prop. Line _- _______'!�"_'t LEACHING LINE No. of Lines ------O"-_.________ Length of each line_ -_ f' Z1___ Total Length ._Z)--U-z-------- /-10 --____ Q D' Box .---_�__.__ Type Filter Material ��`_/U?, —,Depth Filter Material __._. __.__�________________'__._ ` i - Distance to nearest: Well __��'_____________ Foundation -- Property--�------------ Pro er Line, - --------------•----- ” SEEPAGE PIT [ ] Depth ---------- ------ _ _ _ -----------------___ Diameter _ ___ ___ ___ Number ---------- Rock Filled Yes E] No i❑ = Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------- .......... I REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------.___________________) Septic Tank (Specify Requirements) ------------------------------ ------------------- -------- Disposal 'Field (Specify Requirements) ----/_«__t_r- d..--- �`'-- --- -------------- ------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- j (Draw existing and required addition on reverse side) I 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: 1 "I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner F as to becoSublAct to, rk 's Comp n ion laws of California." Signed --------- - --- -- - --- Owner BY --------------------------- - -------- ---- ------- ------------------------- Title --- ----------- ------------------------- (If other than owner) FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY __ _ _______ '- ------------•--- DATE ----- - - -7-1 BUILDING PERMIT ISSUED ----------------- DATE --------------------- ADDITIONAL COMMENTS --------- - ----- -------- ------------------------------------------------------------------------------- --------------------------------- I "------ --- ---- -------- - -------------------------------------------------- -------------- ------------------------------ ------------------------------------------------------------------- -------- ---------- ---- ------------ - --------------------------- --- ---------------- - -- ------ ------ ____Final Inspection b SAN JOAQUIN .LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M