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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ��- -- --- --•--------------- ----- -------- (Complete in Triplicate) Permit No. ------------------------------------------------------ -- �j __ ---------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued __r----e-------- Application /`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 ADDRESSJLOCAT N ._��-�DG' � � ''�'" -CENSUS TRACT -------------------------- Owner's Name ------y�-_-_-�_. �.----- -----------------------------------------------•----------- -------Phone ----------------------------------- Address �� !? �/• / City ------ --- -------------------------------------------- Contractor's Name -- (,�.�_ --- ----.License # -------- ------- Phone ------------------------------ Installation will serve: Resi nce ❑ Apartment House❑ Commercial ❑Trailer Court ;❑ _ Motel ❑ Other __9724- __ (I Number of living units-------- __-_ Number of bedrooms -____Garbage Grinder _----_----__ Lot Size --- - --- Water Supply: Public System and name ---- -----------------•------------- --------------------------------------- ---------Private Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay F] Peat❑ Sandy Loam 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 TREATMENTSEPTICTANK'w Size__� -` r [ 7 [ � � `��----/k--- --- -.�--r..S------ -- Liquid Depth ---- ---------------.----- 0 p yyp �____ NAciterial_ 1�c �_t_ No. Compartments __ D t Distance to near : Well ---------SIC. ...................Foundation ....../U__......... Prop. Line ------ LEACHING LINE 1"] No. of Lines ___A g � _ g j _ _____________ Length of each line-_____-. _A__�_______-__ Total Length .____1�+�____________._ F �, 'D' Box ._ _.._.___ Type Filter Material __� 1�+_____Depth Filter Material ------��_____--------------------_______ Distance o nearest: Well ________ C�_____ Foundation --------/ _______ Property Line ___S_._° ____._.___ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No C 1 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ___-____-_--__---._--_ REPAIR/ADDITION(Prev. Sanitation Permit# -------__------------------------_---------- Date ________________-___________-.____} y Septic Tank (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------ Disposal Field (Specify Requirements) ------------------=-=-- ----=-------------- ---------------------------------------------------------------------------------------- N ----- --------------------------------------------------------------------------------------------------------------- ------------------------------------------------- ------------------------ I - ----------------------------- ------- --------------------------------------------------------------------------------------------------------------------------------------------------------- (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 (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------- ------------------------------------ DATE ------ --- ------- BUILDING PERMIT ISSUED ------------------- ---- ---------------------------------------------------------------------------------DATE _---- ---------------------------------- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------------------------------------------------------------------- Final lns ection b : . "-�- 7 -------------------------------- ---- ------------------------- --------------------- `f _ py -------------- Date - ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M