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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� Permit No. ............ , -----------------------•----••-•-------- ................ (Complete in Triplicate) ..............................•--------...... Dote Issued .�.'�.l'?_. ► .. 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 herein described. This application is made in compliance with County Ordinance No. 549 and existing Rul s and Regulations: _�_e_ 1q_S c�/IU ?fCE RACT ---- ------- -•---- JOB ADDRESS/LOCCATII�O�N/ ------ •1-��—p. ....._._.... L Owner's Name l--I�7/�'• L�•l "' �/.. ,�.._..��1�4-P/ BIZ. ---•---....Phone ------- ---------------- Address --------City • -----•-----•------••..... ..................................... .C, --/ License # -7ct{` Phone Contractor's Name .... .,. �. .:2 / = installation will serve: Residence❑Apartment HHo-useP Commercial oTrailef Court Ll Motel ❑Other ............ Number of living units:...... . ... Number of bedrooms ............Garbage Grinder ........... Lot Size .-... � •••-- Private Water Supply: Public System and.name ---_-__.-__- - Q" w - Character of soil to a depth of 3 feet: Sand% Silt Q Clay Q Peat E] Sandy loam 0 Clay Loam 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'[ j S e......... -•-•••••--- -----------••-••.......... Liquid Depth __.. .............. Capacity -•-- - ...---•-•• Type ---•---•• - Material. .................... No. Compartments -------------••------- • Distance *to nearest: Well ....... . . ......... .............Foundation ............---_. Prop. Line ..._...._..._..---.-- . Total Length .. LEACHING LINE [ ] No. of Lines ngth of each line____._..-•-.--•--- .•-••_.....__... Depth Filter Material 'D' Box Type Filter aterial .. ...... Property Line -------------•-----..... Distance nearest: Well ____ ___________ _____ Foundation P rtY SEEPAGE PIT [ ] Depth __`........ ..... Di meter _•_-____.----__ Number ----------- ---------------- Rock Filled Yes ❑ No 0 t Water Table Depth ---------------•---- --•----Roc Size -------------------------------- Distance ------_- .--.---..----- ------ il 1 -------------Foundation Prop. Line ------ ............... Distance to nearest: ell ........................... --••-••••---•••-•••• I ...... Date ---•-••-------------------------- REPAIR/ADDITION(Prev. Sanitation Permit --------• ------- ----- -- -•-• - e Septic Tank {Specify Requirements) ..................__ _. - Disposal Field (Specify Requirements) �`'�L . •---.... ----.71)•- -- •� � ;may..----•may . .. - . ... - . .. ....... .......... ............ ---- (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 Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: anon In such manner "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any p as to become subject to Workman's Compensation laws of California." Signed . - - -- •-----•-�--• --------- ----------- ......... Owner - ---------- title ----•---------•-••- .. ---- --- - --- {If other than owner) FOR .DEPARTMENT USE ONLY ' DATE .7.- ...--•-•-. APPLICATION ACCEPTED BY -•--- '.._ ... - ..... BUILDING PERMIT ISSUED ............. ... .. f : G� ADDITIONAL COMMENTS - - - . •. ............. ------------------• ---------- ----------- ......... ........... �.a -------- o--- ............................... Dote Final Inspection by: --------- -� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9. 1-'68 Rev. 5M