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FOR OFFICE USE: APPLICAMON FORS SANITATION PERMIT Permit No. _ -_.-"----- ---- ---------------------------- ------ (complete in Triplicate) ---- 1-------------- - + Date Issued __ This Permit Expires 1 Year From date issued -. __ _____ -------- Application is hereby made to the San Joaquin Local Health District for a2 permit to construct and install the work herein described, This application i made in com Iiawith�Co-`ung Ordinance.No. axisting Rules and Regulations: ----------- ---------- - --- - CENSUS TRACT ---------------------- JOB ADDRESS/L TION _-- ---'----- + .= "` Phone --------------------•--------------- Owner's Name City ---------------------Phone----------------------------- Address �- ------ -------- .. - _ .__ License # Aff-3� --- Contractor's Name ------- Installation will serve: # Residence E Apartment House❑ Commercial ❑Trailer Court l❑ 1 Motel ❑Other __ -------------------------- nits: ------------------------- • Number of living units:__...-l-.__ Number of bedroo s _3------Garbage Grinder .._.... .Lot Size ----fid-- - F �'� Private.[A_ Water Supply: Public System and name ------------------------------------ -- ' Character of soil to a depth of 3 feet: Sand❑ Silt E] clay F] Peat El Sandy Loam Clay Loam El Hardpan Adobe' Fill Material -------- --- if Yes, type --fie.---laced on--- P ❑ ❑ r buildings, etc. m p reverse side.) tj [Plot plan, showing size of lot,ilocation of system in relation to wells, NEW INSTALLATION: {No septic tank or seep -pit-permitted if-pu blit-sewer-is-available-within 200 feet,). i Liquid1De th .--------------"---•------•- SEPT.IC-TAMC Size`F ' ---- -------- p PACKAGE TREATMENT I ] I �Lc No. Com artments f' -- Material- - ------ --- - - p ��-------------- Capac+; .�?o t?- tTYpe P k Foundation --- ��' - Prop..Line ` == -------- i Distance to near t. Well. r ---------------- Total Length� � ----"-- LEACHING LINE [ �No. of Lines __..__ ,_..---------- Length'of.4each line - d ' �9 _ i 'D' Box.__--- Type Filter Material ... .__i- ---- --Depth Filter Material ►- -------------- Distance -- -------------- d r ----- "� Property Line Distance to nearest: Well ---�--- -------- Foundation .-- --- _�''------ -� p � [ Depth .-- _ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ SEEPAGE PIT [ ] p - -- �---�- 4 Water.Table Depth` -- -------- -------- ------------------------ Rock Size -------------------------------- 11 1 , ' Pro Line ---------------- _. -"......._..._Foundation p• Distance to nearest:Well'^---=--'-°"'------; " ------------------- ------- ---- Date ---------------------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ---,---- ----- --- ---- f w ,. �.. _. --------------- -,.-.- Septic Tank [Specify Requiremenfis] ---•----------------------------------- - Disposal Field (Specify Requirements) ------------------ �r Ik --`------------------------------------------------------------------------- --f ----------------------------------------I--- '-------------.._..--------------------------------------------------------- -------- - [Draw existing and required addition on reverse side) I hereby certify that 1 have prepared_this.application_and. that the work`,w,i1L be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health�d'sstrict. Horne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as to become sub' t to Workman's Compensation laws of California." + Signed ---- ----------- Owner -------------- Title --- " . --------- ------------------------- -------------- -- 1 (If other than owner) FOR DEPARTMENT USE ONLY I fDATE ------------------- APPLICATION ACCEPTED BY --------- ------ - - BUILDING PERMIT ISSUED ---------------------------------- -------------- ------------ - -------- DATE ADDITIONAL COMMENTS ------------------------- -- ----------------------------------------------- I - --- ---------------------------------------------i-------------- -------------- --------------------------- --------------------------------------------,-----------------------j----- 1 -x ate J ------------------- -------------------- .T. Final Inspection by..-7_--- ---------------------------- --------------------- 4 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M