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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) ..�.:_::.17.... ....... ..............•-- ............................. ................................................ This Permit Expires 1 Year From Date Issued Date Issued I......... . 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/LOCATIOV 7.FtF _..... ,-. , ...............CENSUS TRACT ..........._............._ I Owner's Name .. ........... -•---- ----• ........Phone . ................................. !�Address ...... .. .......�_��.�-�•.----� - -� - -- - - - ..__ .. .._.... City ....-- ----......--.--...------- ..__............----.............. Contractor's Name . _ -.-' ---•__-_-. w._L'+cense # ABY'.. Phone .............................. . ._.._ . - Installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court 0 Motel ❑Other ........ ........... -----•----....-.... Number of living units:..-/....- Number of bedrooms _--S...-Garbage Grinder ............ Lot Size ..... ....................... ............ Water Supply: public System and name ------------------------------------------------------------------ ----------------------- ........... ........Private [ � Character of soil to a depth of 3 feet: Sand b Silt❑ Clay C] Peat[] Sandy Loam ❑ Clay Loam 0 t 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 [ } SEPTIC TANK[ ] 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 J 'D' Box . ... Type Filter Material ....................Depth Filter Material ......................-.-------..--.--_--_- %n ` Distance to nearest: Well ------------------------ Foundation ....................... Property Line .....__-_----_------- ► SEEPAGE PIT { j Depth ..... .. ........ Diameter .....- ......... Number .............. .. Rock Filled Yes ❑ No 0 Water Table Depth ------.-- --_----Rock Size ................................ Distance to nearest: Well .._...._..............................Foundation _._....._........._. Prop. Line .._.... ............. REPAIR/ADDITION(Prev. Sanitation Permit# ........ .............. -------------- Date _...--------•-•---_-------------.) Septic Tank (Specify Requirements) --...... . . .................. ..... ....•-•._........_...._........_._............................ Disposal Field (Specify Requirements) ._4 oeoeoe .. .. ..... tom' -- .- .'.'.. ..�z..r..-.----..... .. . -.. _ ........................... (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 Joaqul 4 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- "11 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 _!r11417,41------_---_----- BUILDING ..... 1 7y-.._...---_----- BUILDING PERMIT ISSUED/._... ... .. DATE .............................-............. ADDITIONAL COMMENTS/L. or..��_s �t. �. ---------- ------ - y 0 --------------------------------- -. .... ------- *.... - Final Inspection by; ............ ----------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT ;.