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FOR OFFICE USE: -A " .,APPLICATION FOR SANITATION PERMIT .._ (Complete Permit No. ...7 ___ __in Triplicate) -"""" ..............-------.------- i This Permit Expires 1 Year.From Date Issued Date Issued ... 7L 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/LOCATIONS >•ti .......... aG .............CENSUS TRACT .------- -.-_-..--_- baa J Owner's Name - a ..-....... .............................. � •---Phone -4 city ---Address ............................... Contractor's Name --------------I---------------- - --- --� vh---------- ----------License # ll/... Phone Installation will serve: t ,-Residence PeApartment House❑ Commercial ❑Trailer Court .❑. Motel ❑ Other . . . . ............................. Number of living units: ._.._.._ Number of bedrooms ----/-----Garbage Grinder Lot Size - --._. . ----------r..._....--- Water Supply: Public System and name -------------"------------------------------------------------- ---------=- .............Private Character of soil to a depth of 3 feet: Sarid❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam E Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------ - __ If yes, type . -----_-.._ --- -___._..-- (PI'ot plan, showing size of lot, loc tion of system intiefation 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 Dept _ __ ._.___..... ..... I Capacity - ---------- -•--- Type Material_... No. Compartments Distance to nearest: Well --------_---------------------------Foundation _._ -- ----- Prop. Line _._..._._____......... LEACHING LINE [ ] No. of Lines ------------------------ Length of each line ._._^.._. .._.... ...-._ Total Length -----_------ __._-•-_---.-- 'D' Box: ------ Type Filter Material _..............Depth Filter Material _..__-_.-_--____.---.-------------.--.------ ! 'i Property Line Distance tolnearest: Well .._.... --------- Foundation _. p ty SEEPAGE PIT [ j Depth ... --------- ___ Diameter ................ Number -- ---.----------- Rock Filled Yes ❑ No i❑ _Water .Table Depth ------ --- "` - - `R�Sck Size----•I.............. - t --........Foundation ------------ ------- Prop. Line .__.........._ Distance to nearest: Well ............. ""•' I - REPAIR/ADDITION(Prev. Sanitation Permit # _._-------------••--------•---------------�D,-aatte .._. ----------------- 31 Septic Tank (Specify Requirements) .._. Disposal Field (Specify Requirements) // -------•-•----` .......................... t,. . n..._, -:--------------------•--------•---•---••--- - -•---•---•---- --------------- --- --._.... _ •---•--------•- - - (Draw existing and required addition on reverse side) I hereby certify that I have prepare'd 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.JoaquinLocalHealth District. 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 any person in such manner as to become subject to Workman's Compensation laws of California." Signed ! - ------------------- Owner i - Title BY - (If other th owner) _- '�"FOlt'DEPARTMENT USE'ONLY APPLICATION ACCEPTE BY _- �_ ----- DATE .............•--•-----•---•---••------.-. BUILDING PERMIT ISSUED ------ ..DATE ------------- ------------------------••--- ADDITIONAL COMMENTS :i •-• ............................. - - •---•-----•-••--- --•-----••---- --- ----- ----•-• -----------------•---•---••. --._..._ ----------••..... ---------- -•----- -- ---•----•-------------- -- ••---- -- -- • - -•--------------Date ---•-----`�--------•-�-•---•--•-•------- Final Inspection by: -•-- -�` -- ---•------------- -••--•- ---•• -•-- •- -.---• ----_--- SAN JOAQUIN LOCAL HEALTH DISTRICT