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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � ----- - ---------------------------• Permit No: --746 (Complete in Triplicate) ______ This Permit Expires 1 Year from Date 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 Jwith Count/Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --- .��_--0,2----" / g� —-- /�t -------------------------------------CENSUS TRACT -------------------------- Owner's Name __.-__ .� _+Q____ Phone ___________________ Address <r"'r- --- ----(/------------------- ------------------- City ----- r Contractor's Name ------------+ _-. --------------------License # ---------:-------------- Phone ------------------ --•-------- Installation will serve: Residence Apartment House-0 Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units_____________ Number of bedrooms ---------.--Garbage Grinder ------------ Lot Size ____________________________________________ Water Supply: Public System and name ------------ --•------------------------------•---•-----•--•---•----•--------••----•-----------Private ❑ Character of soil to a depth of 3 feet: SancIfEr Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe❑ Fill Material ------------ If yes, type ____________________________ (Piot 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 f ] SEPTIC TANK f ] Size------------------------------------------ ----- Liquid Depth __----_--------------.---_. Capacity -------------------- Type -------------------- Material--__ ---- No. Compartments ------ --------------- Distance to nearest: Well ------------------------------------Foundation ___________________ Prop. Line --------------------•_.-� LEACHING LINE [ ] No. of Lines ______________ Length of each line---------------------------- Total Length ----------- ................ N 'D' Box ------------ Type Filter Material ____________________Depth Filter Material --------------------.___________--__•---_--- 0 Distance to nearest: Well ________________________ Foundation ------------------------ 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'-------........................... Septic Tank (Specify Requirements) f J/ t L Disposal Field (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: 'f "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 bec me s ct to Workman's Compensation laws of California." Signed -__--__ -. - " Owner BY . . ----- Title ------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ F----------------------------------------------------- DATE ------ ---------- BUILDING PERMIT ISSUED --------------------------- -•------ -- ---- ----------------------------DATE ------------- ----------------------------- ADDITIONALCOMMENTS ---------------------------------- ------------------------------------------------------------------------------------------------ ------------------------------------------- ----------------------------------------------------------------------------------------------------------------------- --------------------------- ---------------------------------- _ f-- - Final Inspection by: -- ---------------------------------- --------------------Dated- f¢ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M