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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- [Complete y in Trig icate ------- ------------------------ ►�f Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District. for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations ---------------------------CENSUS TRACT -------------------------- JOB ADDRESS/LOC ON ��ti--��-- - -- - ----�� - -��-----� *"�-` Owner s Name - _ �•�-- -------------- -------- ------------ --------- -- Phone --------=--------------- Cit --------------------------- --------------- Address ---------- Y I -------------- Contractor's Name _-.. License # Phone -----'---- ----- ' --- --- ------ ---- ----- ------ Installation will serve: Residence Apartment House Comm ial [ Trader Court ] JJ Mote! ❑ Other Number of living units:----/___-.- Number of bedrooms 4------ Garbage Grinder ------------ Lot Size ---4 ----- ------------•-- Water Supply: Public System and name --------------------------------------- ----------------------------------------------------Private Character of soil to a depth of 3 feet: Sand[] Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ `Clay Loam ❑ '� ' Hardpan❑- Adobe'p9 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 Jp blit sewer is available within 2d0 feet,) / ` _ - . Liquid Depth -------------------- \ PACKAGE TREATMENT I ] SEPTIC TANK J Size - --__ _____ ! Capacity � _____,__ Type -� •-Iry Material------ Compartments �-.-------- D/ i --- -- -------------Foundationf, ---_---- Prop. Line ------� �J p .• Distance to nearest: Well Length of:each line__'_ �s�. __ ._..__ Total Length = - ------ W 9 t LEACHING LINE �%j No. of Lines ------- ------------ g , t D' Box '_._.__ Type Filter Material __ : -'�---'-Depth ter Material __ _ - -•------ �'� Distance to nearest:arest: Well ____-�� Foundation --- - ---------- Property Line --- --------------- No--- �� SEEPAGE PIT Depth Diameter __��_-_-- Number _-------_./.__-_-___ _ Rock��led Yes [ No .❑� Rock Size Water Table Depth ------------------ ------------ ��d Distance to nearest- Well --_-__-,l -__ --------Foundation �_.__-.------ Prop. Line ._.__..___;-. REPAIR/ADDITION(Prev. Sanitatiori Permit# -------- ------.-- -------------------------- Date ------------------------------ �.Septic Tank (Specify Requirements) : ' ---------------------------"------------- --------••--- --------------- �r Disposal Field (Specify Requirements). ------------------- --- ------ ------------------ F. I ------------------------------------- _______________"__-_---._._.---_--_____---____----____-_-------------------------------------------------------------------------------------------------------- _____________________________ _ _ ----_ - _-_-_-.____ ----------------------------------------------------------------------------___-__--._---_- _----__--------_----_. .___-__---_ _._ (Draw eicisting and required addition on reverse side) I hereby I ertify 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 Work ! 's Compensation laws of California." Signed -- --- -------------- = ------ - -- - ----------------------------- Owner ------- `------------- Title --------------------- -------------- ---------------------------------- By ------------------- I (if other t an owner) FOR PA NT USE ONLY DATE ____._ --- ---- APPLICATION ACCEPTED BY ___________ _____ - --- BUILDING PERMIT ISSUED ---- -- -- ------------- DATE ------------------ ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------- - ---------- -----------------------------------------------------------------------------=--------------------------------------------------------------------- ------------------------------------------------ ------------ - ---------- - - --------------------------------- ----------------------- ---- Final Inspection b r 7 -- - ------------- ---- -- -- - ate ----- - SA -- -------- --- -- ------- CAL HEALTH DISTRICT �: E..H. 9 1-'68 Rev. 5M