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FOR OFFICE USE: ____ -. -- APPLICATION FOR SANITATION PERMIT ---- (Complete in Triplicate} ------------ ---- ---- ---- - Permit No. - -- -•-------•- ""-" -`------ This Permit Expires 1 Year From Date Issued Date Issued -S`_-�_ 7 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 unty Ordinance No. 549 and existingRule JOB ADDRESS/LOC' � - .- sand Regulations: ----— Owner's Name l --------------"CENSUS TRACT --- Address -- _-_.-- _Phone._---- " ----- .� _- ------------------- --Contractor's Name --- .J_ - ------ City ---------- � ff� — --------- ---------------- AfC 'L. [nstaliation will serve: - --- -------- -- License:#.._y"i._3_�'�-- Residence q _Phone________________._ Apartment House❑ Comme Motel ❑Other rcial ❑Trailer Court ❑` ? s ------------------------------ Number of living units:-----.-"_"--.Number of bedrooms Garbage Grinder __-__ - Water Supply; Public System and name _ _ ____ Lot Size _________ Character of soil to a depth of 3 feet: Sand' --- - -- ---- ---------------•------------- - _Private EJ Silt❑ Clay ❑ Peat❑ Sandy Loam [ I Clay Loam f Hardpan El Adobe ❑ Fill Material _.____-_____ Ifes, y type ---- -------- (Plot plan, showing size of lot, location of system in relation to- wells, buildings, etc. must be Placed o NEW INSTALLATION: (No septic tank or seepage t permitted if public sewer is available thtin 200 feetn reverse side.) PACKAGE TREATMENT p� I ) SEPTIC TANK'[ ) Size______________ i .1 --------•------------ ---- Liquid Depth ---------------------- Ca Size- Capacity --�-" " Type -------------------- Material---------------------- No. %Compartments ------ Distance to nearest: Well ------------------ Foundation --------- . LEACHING LINE [ ] No. of Lines ------------------------ -- Prop. Line ------•-----•_---__ Length of each line ---------- TotaP Length ----------•- 'D' Box - ----- --- T � -----•-------• O � Type Filter Material ___________________Depth Filter Material Distance to nearest: Well ------------------------ - ---------------••---------------------- Foundation --------------------- -- Property Line --- SEEPAGE PIT Drn [ ] epth -------------------- Diameter __ Number ---------- "-"-"""-"""""- ------ -__:_ Rock Filled Yes ❑ No Cater Table Depth ------------------------------------------------ C --••------- REPAIR /ADD1TiON(Prev. Sanitation Permit# .. Rock Size - ------- ---------- Distance to nearest: Well .Foundation -------------------- Prop. Line --------- ------ ------ _-_-"•--_-__---__ ----- ------- ------ -- Date ------------------- Septic Tank (Specify Requirements) } --------------- --- isposai iel (Spedfy Requirements] _ ----------- --- ----T ------ ------- - ------- --- --------- - - - ------------ ----- -------------- v . ;; --.------------------------------------------------------- ------------------------ ------------------- --------------------------- -(DrdWexi-sting-'an l-Trequired-addition on reverse side) { I hereby certify that I have prepared this application and t6at'the w,b k 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 erfor I ��' p f the work for which this�'W"It is issued, I shall not employ any person in such manner as to become subject to orkmq ,s Com at'ron laws of California." Signed -------- ------ ------ ----- ------- .;- - - -- -- ------------i - --- -- -----�-------- Own BY ------ ---- - -'- p � ---- ----- ------ Title `� ! o herthanowner} � ----------------------------------------------------- FOR ------------- " FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY "_ PERMIT ISSUED --------------- - ---_ . DATE ___� 7- _ --3 ------------------------------------------ BUILDING ADDITIONAL COMMENTS ----______________ - -- ------ -------- ---------------- --- -------- -DATE ------- ------------------ - ------------------ - - --------- - Final Inspection by: -- -- -- - ------------- - -- - -------------------------------------------------------- ---------------------------------------------- --- -- Date --------- ----- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. i #'