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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT f --------------------------------------------------------- (Complete in Triplicate) Permit No: This Permit Expires l Year FromDate Issued Date Issued _ __ -------------- --- ------------- _--------------- . 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 existing Rules and Regulations! JOB ADDRESS/LOCA ON ------119A0_ --- --CENSUS TRACT -------------------------- Owner's Name /1� - Phone _ Address -- ------- T +4eF_1 ---- ------------- --- -------• Cityk r "'1 'r'�--------------------------------•------ Contractor's Name _.__ -�_- - - -= - -r-.License # .f�� _ ''_ Phone Installation will serve: ResideApartment House❑ Commercial ❑Trailer court ;❑ Motel ❑Other _ Number of living units:-_`______ Number of bedrooms ---—_____Garbage Grinder __- ------ Lot Size ___________________ ---------- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private ------------------------------•-------------- ---------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam j] Hardpan W Adobe ❑ Fill Material ------ If yes, type ___-______------------ ---- (Pl'ot 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'[ Size-_44L X. S__1------------- Liquid Depth ---V---------- ---- O Capacity .� aO_` Type -4�--_ Material---??� ---- No. Compartments _ _______________ r I Distance to nearest: Well ---------`Sa--------------------Foundation -----/a------------ Prop. Line ---_- ---.-.-:--__-- LEACHING LINE [ Na. of Lines -- ------a(------------- Length of each line_____ _ 'a__r___._____ Total Length :�_/�-°_ _ _ _ _ .- 'D' Box ----- -- Type Filter Material __-__ ______Depth 'Filter Material ___ ____ r Distance to nearest: Well -------�.a_'_--------- Foundation ________-VC!-------- Property Line ___________ SEEPAGE PIT [! ------------ Depth __-_,�- __!___ Diameter ___ 3 h__ Number ---------1----------------- Rock Filled Yes �No I❑ Water Table Depth - ------------------t -Rock Size ---- Distance --Distance to nearest: Well ----------- _°------------------Foundation -----/4_________ Prop. Line ___s_________--__-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -_--------------------------------1 Septic Tank (Specify Requirements) ------------------------------ --------------------- ------------------------------ --------------------------- Disposal ----------------t,.-------------------------•- Disposal f=ield (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: t �. "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -- ------------------------------------- - ------------------- Owner + By ------------------------------------ ----------- -------- Title - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ __ --�-- ----- DATE - -7-- - ----------------- - ----- BUILDINGPERMIT ISSUED ------ --------------------------- -------- ----DATE ---- -------------------------------------- ADDITIONALCOMMENTS ---------------------------- - -- ------------------------------------------------ ------------------------------------ ------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ --- --------------------------------------------- - -- - r ___________________________________ __ ___ ___:_ __ _________.________________________________..____.___________________________ ___ ___-_____ _ Final Inspection by: -- - = --------------Date ---------�� -- - ------- ri SAN JOAQUIN LOCAL HEALTH DISTRICT'= E. H. 9 1-'68 Rev. 5M vr_