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APPLICATION FOR SANITATION FER,=vilii'r --.... ....- {Complete in Triplicate} Permit No. - ------------- ----- -------- -------- 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 tfie work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Rc;gulritions: JOB ADDRESS/LOCATIPN •r '�, . ! :< '- :`: CENSUS TRACT _ Owner's Name Address �: - City --------- Contractor's Name ...... J. ...... ' -_License # . ... .-- . Phone ... .. Installation will serve: Residence ❑ Apartment House❑ 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: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam I❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ---------- -- If yes, type ........ ........ ..- o ,Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 'w NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size________________________ -_ Liquid Depth _ -- _ . _.-- ...-- -- I Capacity - - -_ -. Type ...... -. --- Material--- - - - :.-. No. Compartments ----------•------- Distance to nearest: Well ........... . . ----------Foundation . .. -- Prop. Line ..-----------.---.-_-. LEACHING LINE No. of Lines __ f . Length of each line-_ Total Length ------ ..._............. 'D' Box __ Type Filter Material __/_Z_-�.'_-_-_-_Depth Filter Material ....... ... . ..... ......... Distance to nearest: Well - J_- _.. . Foundation - ' _'. - .. Property Line ..... -'---------------- SEEPAGE PIT Depth ----------------- -- Diameter - ------------ Number .............. ...... .--.. Rock Filled Yes ❑ No '❑ Water Table Depth --.-------- -----------------------Rock Size ---------------------- - - Distance to nearest: Well ------------------ -----Foundation -------------------- Prop. Linc ..... .... ........... REPAIR/ADDITION(Prev. Sanitation Permit# ......... Date ----------------------------------) Septic Tank (Specify Requirements) ...... . ....... ---------- ---- - .. ... /------ ---- ------ -- ..---.._..:._ W - 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 Dis.rict. 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, 1 shall not employ canny person in such manner as to become subject to Workman's SlgnedCJjG--rJrL_1� -.-_J _ ACom..�p, � ^ laoff 5 aliforn ia." � ..-.:..... -- Owner ner--- - --- .{/ .� (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY C _-- ........... --------------- DATE - BUILDING PERMIT ISSUED -- -- I..... .. -------- --- --- --- --- ------- ------ ... DATE ADDITIONAL COMMENTS ----- -- --- --- - /. - ..- ----- --- --.-. .. .- .... -t. .... .a< - .. anal ln,pecion by: .. .. .. ...... . .... Date , r. SAN JOAQUIN LOCAL HEALTH DISTRICT E- H. 9 1-'68 Rev, 5M