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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ` 0.6 Permit No: ?' - --------- ------ (Complete in Triplicate) ------------- ------------ Date Issued This Permit Expires 1 Year From Date issued -- - Application is hereby made to the S n Joaquin Local Health District for a permit to construct and install the work herein described. This application is made incompliance witl} County Ordinance No. 549 and existing Rules and Regulations: 1 ' --- 3 _ ' - -----------------------CENSUS TRACT -------------- ----------- JOB ADDRESS/LOCATION ------ ` '�- - ----- � _ DOwners Name t --- -•----------�--- Address ----------------- ------------------------------- City - - -----:--- # 75ne License Pho --------- Contractor's Name Installation will serve: ,r.'`: Residence Apartment House❑ Commercial ❑Trailer Court ❑ M tel ❑Other - - ------ --------- ---------------- Number of living,, units:_- a__ Number of edrooms ___ __ Garbage Grinder t11 Lot Size -2--- - Private ❑ Water Supply: Public System and name Y �� ` .- -A _ Peat Sand Loam .I] Clay Loam ❑ Character of soil toTa depth of 3 feet: Sand Silt ❑ Clay ❑ ❑ Y Hardpan Adobe, Fill Material -------- --- if yes,type --------------------------- ` i -plot plan, showing size'of lot, locatiornsystem in elation 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 �. .... ,._ Depth --------------- Material = ------ ------- --,----- m Capacity------------------- Type ---------------- ----------- 4 artments Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- r � f LEACHING LINE [ J No. of Lines ---------------- -------- Length of each line---------------------------- Total Length ----------,---------•--•----- 'D' Box t----------- Type Filter Material --------------------Depth Filter Material --------------------------I----------------•- t # - Foundation ------------------------ Property Line ------------------------- Depth ----- --------- Distance to nearest: Well ____________°_-______- --'-•-" De th Diameter ----- Number ---------------------------- Rock-Filled Yes ❑ No SEEPAGE PIT [ ] p - ----------------- t Water Table Depth Rock Size -------------------------- ----- F i .y ----=- :Foundation ------ Prop. Line ; Distance to nearest: Well ______________________________ _ ,ex, w,.---I REPAIR/ADDITION(Prev. Sanitgtion Permit# ------��--------------------------------- Date.---------------------------------- V - Septic Tank (Specify Requirements) ----------------�---------------;------------------------------------------�-- ---------- � ----------- ------------ V- - Disposal Field (Specify Requirements) __-•-----.__---.:�O -------------------------=--------------------------------------------------•--------------- -------- t -- --------------------- ----- ------------------------------------------ -------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this applicatiorx 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed Y ----- Owner ------------------- ------- Title ----t__=G -"-��t (If er than owned I F EPARTMENT USE ONLY y APPLICATION ACCEPTED BY = --=---------------- DATE { " BUILDING,.PERMIT ISSUED = ----------I--- ` f :----------------DATE -------------------------------------- t ------ ADDITIONAL..COMMENT s :1- - --- -------- ------------------f---------------- f - ---- a 4 ----------------------------------------------------------- �� -- ---- x ---- ---- -------------- --=- ------- ---- ---- ---- - - a - - --------- - Final Inspection b Dte -f ,s SAN JOA IN LOCAL HEALTH DISTRICT - - ---� -- -»T , . , ... &_ - E. H. 9 1-'68 Rev. 5M. y