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' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ....".........._ -. .........................:....... ------- (Complete in Triplicate) Date Issued This Permit Expires 1 Year From Date Issued ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her described. This application is made in compliance with County Ordinance No. 549 and exis ' g R�le �n9ulations: I // ' A TRACT --- �t'- -. (csC..r CENSUS ----------•------ JOB ADDRESS/LOCA ION .r` - "'ft"t" '" """" " Phone "" Owner's Name N✓ - . ................... Address r -License'# . . .�, Phone Contractor's Name .......... . ......... {= ' Installation will serve: Residence E Apartment House❑ Commercial oTrailer Court 0 Motel ❑Other -------------------------------------- . Number of living units:.......... Number of bedrooms ..........Garbage Grinder ""..._----- Lot Size ---------------_....... �/ -- Private iJ Water Supply: Public System and name ---------------.-......•................................--------- Character of soil to a depth of 3 feet: Sand'❑ Silt Clay .❑ Peat❑ Sandy Lonm{ Cloy Loam[] C] 1 :. Hardpan ❑ Adobe-[] Fill Matenal ._.__..""_ 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 seep ge pit permitted.;a-""X-.-��-.public sewer is available within 200 feet,j SEPTIC PACKAGE TREATMENT Size" + TANK[� ------------- P Liquid Depth ....................... tl [ ] , _ -!r- ..-..•- Liqu ' Capacity ...LZv d Type '`` `m" Material.C �" Q----- No. Compartments.-r----------=.... '-r S d Foundation -.1.0._ " Prop. Line ..--sS......=•------- Distance to nearest: Well .........."....................... . I - - ' LEACHING LINE„[�No. of.Lines ,,�__.._:__"_.:_�"e._ Length of•e- ach line....... s_.4..'..""-"---- Total Length .1.0.0...... .... 1.0.a................. ' 'D' Box .11-R.... Type Filter Material ..... Depth Filter Material ._.1.%".1............-..........-••.-- . .. Foundation �o Property Line .`5.....-.--.--••----- Distance to nearest: Well ---..,�..-�--- -- --•••--••--""""" SEEPAGE PIT [ ] Depth ............ Diameter Number ...."....................... Rock Filled Yes ❑ No 0 ' Water Table Depth ---•-- ----------•-------- ---Rock Size ..-----------------------------P Distance to nearest: Well ........................................Foundation .................... Pro Line .........-...... ----- REPAIR/ADDITION(Prev. Sanitation Permit#................-------. Date ...--------_----------------..----I Septic Tank (Specify Requirements) ..................................................................................----............ - Disposal Field (Specify Requirements) ......--•.........................t.------........................................_..... ........- - - - ............... . ----------------------- .......... ....................................................... (Draw existing and required addition on reverse side) ' 1 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 HealthDistrict. Home owner or licen- sed agents signature certifies the following: ' "I 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 beta s jeet to Workman's Compensation laws of California." Owner Signed .. . ............. - ----- ' _ Title; -dx�.'� -- _ - ."...-----.". By (if other than owner) FSR DEPARTMENT USE ONLY .. APPLICATION ACCEPTED BY _." . ..... . .... .......".."...... _ - .....................----.........-----....... DATE .y..>.✓�.@.... -t'-------- BUILDING PERMIT ISSUED ".........................................------- I--------.................. ....................----DATE .......................... ----- ADDITIONALCOMMENTS -................................... ..................................... ........ .......................................... - ------------------------------------------ .-. ---------- ............- ---- - - - - ----- ......... --- ---- --- -------------- ---------------- -- ----------------------- ---- ...Da. Final Inspection by: ................... ------:-- .... .....�.. ..... yry - - .._. --.. te .- - --- - ..1.•-.E - ............ .... --._.... - ..... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev" SM