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FOR OFFICE USE: APPLICATION FOR SANITATION PERMi f Permit No. (Complete in Triplicate) ----------I..........................-.-•---------------- _______............_ This Permit Expires 7 Year From Date lssue T(OP ed --- 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'`) -�_.------ --'--" ... ' .. ,ft%f'-------------...................CENSUS TRACT Owner's Name - s� .�� ..... - .. Phone ....... Address .::. city _ +>, �c�� Contractor's Name .-r!v --------------------------------------License # ......................... Phone ........... .................. Installation will serve: Residence Apartment Houseo Commercial❑Trailer Court C] II Motel ❑Other............................................ _ Number of living units:...!..... Number of bedrooms_----Garbage GrinderkA°-,5_ Lot Size ��r r ,� . ................ Water Supply: Public System and name -----------••--•----••---•-•-- ---------------•------....---------- ...................•----------------.. _Private Character of soil f a depth of 3 feet: SandEJ Sift❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam Hardpan ❑ Adobe-[] Fill Material ............ If yes,type ............................ 1 (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`available within 200 feet,! PACKAGE TREATMENT [ ] SEPTIC TANK Size.- ---,fz. .x" ....... .:............ Liquid Depth .................. iI Capacity/" - Typeff?f r .. MaterialNo. Compartments �' Distance to nearest: Well .__........ l�..................Foundation ZZs__._..... Prop: line ..�. _+___. LEACHING LINE ] .No. of Lines ------------ Length of each Iine��Q ---------- Total Length ;Zle 412.............. I. 'D' Box _.J Type Filter Materia��l�--Depth Filter Material ---------------------------------- .w ..................... ....... Distan6e to nearest: Well ___ . . Foundation - _._ .�y ?--•-- ---...__.. Property Line .............. SEEPAGE PIT' Depth _li+.___�_-_-_ Diameter r1.��.. Number ... --_-.__-.._•-..._._. Rock Filled Yes No 11 1, gg--.4. Wafter Table Depth ....... �-----------------------------Rock Size---_s,? ________-_-••-•- ...i i p j Distance to nearest: Well .... !____________________Foundation __�r�.._..... Prop. Line Ap ....... REPAIR/ADDITION lPrev. Sanitation Permit# -------------------------------------------- Date ...........___•-------------------I SepticTank (Specify Requirements) ----•-------------- ------------------------------------------------------------------------ ------------------,.......•-•-••----•---------- u 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 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ......... ------ ----- Owner BY ---- •------------ ... .................... .Title . .. - il(if of than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ----••--------------------------------------------------- DATE ..........•... BUILDING PERMIT ISSUED -------------------------------------------------- --------------.-._ .........DATE ------------•- -_- - ADDITIONAL'COMMENTS ------------------ ----------------------- --------•-------•............ •------••--..-.._...----...-..--------------------------•-•------...----------------- -------------- -------•--------------------------------------------------------=---• ---------- ---------------•---- .......................................... ....... ------------------------ -------------------- -- --- ------------ -------•- .............................................. ............. ...... ��, -. Final Inspection bY� ---------- - - -- --------------------------•-•-•--...._.......................------...--------_.Date -- ------ .- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M