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FOR OFFICE USE: W l APPLICATION FOR7SANITATION PERMIT 3------------------ --- - (Complete in Triplicate) Permit No. -- ------------------ This Permit Expires i Year From Date Issued Date Issued X/ 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 madein compliance with County Ordinance No. 549 and existing Rules and Regulations: edJOB ADDRESS/LOCATIO �_f�1_._ _-- -----iV �GL_ --------------------------CENSUS TRACT ------------------__--- --- Owner's Name -------- -- -- Phone _ ---- -- ---------- ---- Address I V r � ---------. City J,, ------------------` Contractor's Name . "'� -4 r---- - -- -c -----------------.License # ------- ----------------- Phone Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court l❑ IMotel ❑Other -------------------------------------------- Number of livingunits------------- Number of bedrooms ________ _Garbage Grinder/G/0 Lot Size ________ __ ____ Water Supply: Public System and name -------------------------------- •------- --- ----------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay J] Peat F] Sandy Loam E] 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 [ J SEPTIC TANK f ] Size-----------------------------------•------------ Liquid Depth -----_---_----------,----- Capacity ------------------- Type ---------- Material----------------- ---- No. Compartments ---------------------- Distance to nearest: Well __--Foundation ---------------------- Prop. Line .___.-___.______._..._ �. LEACHING LINE [ I 'No. of Lines ______.__._ g _-___.______ Total Length ,_"--___ --- -- Length of each line--------------- --------------- 'D' ---------_-_-'D' Box ---------- - Type Filter Material --------------------Depth Filter Material ____________________k_- fir Distance to nearest: Well Foundation �._{___,1�_ Property Line ___-_°___________� SEEPAGE PIT [ ] Depth ------....-_.' _�'Diameter ---------------- Number ____________________________ Rock Filled Yes ❑,„�,No C] Water Table"Depth----------------------------- -----------------Rock Size -------------------------------- Distance to nearest-Well --------------------------------------- Foundation -------------------- Prop. Line.---------------------- r � REPAIR/ADDITION(Prev. Sanitation Pirmit# -------- ----------------------------------- Date --------.------------------------_) Septic Tank (Specify Requirements) --------------------- ' ---- ------ --------- ------ ----------- Qis sal Field (Spe 'fy Req ements) _____ _ 4 } R - - ----------- - - ---- or I �. t - ------------------------ ----------------------- ----- - ----------------- -- - ------ - - --- .r.{. . ,. {Draw existing aril 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 imthe 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/ l ----- ------ -Title -------4&6f- (If of erth caner) I FOR DEPART E JDNLY APPLICATION ACCEPTED BY .__. --- ---------- ---------- _ -------. DATE BUILDING PERMIT ISSUED ----------------------- s_: �hj _i DATE--------------------- ------ ADDITIONAL COMMENTS ---------------------------------------------- - --- --------------- ------------ -- ---- -------------------------------------------- ---------------------------------------------- ------------------------------------------------------------------------ -- ---------- -------------------------------------- ---------------------------- ------- ------ ---- -_ ----=-- -----------x----------------�// ----- ---------- -------------------------------------------------------------------------------------- - -----=------- Final Inspection by: ----------------- -- ---- -------Date ------- --------•------- SAN JOAQUIN LOC HEALTH DISTRICT _ E. H. 9 1-'68 Rev. 5M