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FOR OFFICE USE: APPLICATIONFOR SANITATION PERMIT 9 # ______ : O - ---------------------- P ..[Complete in Triplicate} Permit No. -__��'- ---------- ----- Date Issued ----------------------------------------------------------- This Permit Expires i Year From 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/LOCATION -------7-Va__ �C��l_!-__ ____________f�YYi._I��._ CENSUS TRACT __�=-�-.�---__- l Owner's Name ------------ '-l•.r fir• / aler------------------------------------------- ------Phone Address _ S- J� ` ---•• ~ ------------ -------- -- --•-•----••----- Contractor's Name --------- --------^----- -------------------------------;-------.License # ---------- -- - ------- Phone ------------------ ----------- Installation will serve: Residence ❑Apartment House^❑ Commercial ❑Trailer Court ',❑ Motel ❑Other ------------------------- ----------- [ t Number of living units:_ Number of bedrooms ------------Garbage Grinder ___________ Lot Size -------------------------------'__________- Water Supply: Public System and name ----------------- ------------------------------------------ -------------------------------------------Private El Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe '❑ Fill Material ------------ If yes, type _____.___________________ A (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,) k PACKAGE TREATMENT [ ] SEPTIC TANK T ] Size________________________________________________ Liquid. Depth ------------------I--------- Capacity ------------------- Type--------------------- Material------ ------ No. Compartments -------------•- ....... [ Distance to nearest: Well ---�--------------------------------Foundation -------:------------- Prop. Line ---------- } LEACHING LINE [ ] No.-of-Lines ___-_______________' Length of each line--------------_-----__ _--,Total Length _____t_____-____:_________._ D' Box _ ______-_ Type Filter'Material --------------------Depth Filter Material _-________'_ E Distance to nearest: Well ________________________ Foundation ------------------------ Property Line _`_____-___'_ + SEEPAGE PIT Depth --- -------- Diameter ____-- ____---- Number ____________________________ hock Filled Yes ❑ No 0 - -- ---- - _ E Water Table Depth ------------------------------------------------Rock Size.--------------------- ------ a - r Distance to nearest: Well .---------------------------------------Foundation ------ Prop. Line -.-------.`_---------__ REPAIR/ADDITION(Prev. Sanitation Permit#, -------------------------------------------- Date ---_______________________________} ; 'Septic Tank (Specify Requirements) - ----------------------- --------------------------- ------------------------------------ --------------------- Disposal Field (-Specify Requir ents) -_ _______ _ _ __ _ -- ---------------------- r ��' _:: : _ :: -- -_ -- --------------------- 41-1 L ______________ - F--------------------------------------------------------------------------------------------------------------------------------- F q (Draw existing and iequired addition on reverse side) I hereby certify that l 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: Ilcertify 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 bject t Workman's Compensation laws of California." Signed �/� ��A-e --------------------- OwnerBy ----------------------------------------- ------ I--------------------- ----------------------------- -Title ----------------- -------------- --------- (If other than owner) FOR DEPAVTMENT USE ONLY APPLICATION ACCEPTED BY -___-__ __ - -------------------------------------------------- DATE - BUILDING PERMIT ISSUED -----------€--------------------------------------------- ----- --------------DATE -------------•----------- --------�-- - ----------------- ADDITIONALCOMMENTS -- ---- - 1 ----------------------------------------------------------------------------------------------------------------------------- --------------------------------------------- _ - - _ �2 --------3 � Final Inspection by. - ------------ Date ------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M