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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------------- Permit No. _ _r_ s 1 r ;Complete in Triplicate) --------------------------" This Permit Expires 1 Year From Date Issued Date Issued -.___" -_70 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 1n compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---------- lb-g�-----CENSUS TRACT -------------- Owner's Name - ---- ----- - ------- - - --------- --------------------------------------------- -------------------Phone ------ �j . Address _ . (� i '- City Contractor's Name ---- --------------' l License # Phone , installation will serve: Reside ce ❑Apartment House f-] Commercial:[ Trailer Court C] Motel ❑Other -------------------------------------------- Number of living units:____-r --__ Number'of bedrooms ----.--Garbage Grinder --— Lot Size __"--__----.------"-------------------- Water Supply: Public System and name ------------------------------------------------------------------------------------------------------------- [� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ,❑ Clay Loam;©� Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- (Plot -------------------------_(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) La t _ 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTICTANK;[T Size""-�_�X__ __�X_ ---------._ Liquid Depth el-------------------- V Capacity .._'.ypa_ _- Typed�'�------ Material---- _ �No. Compartments --- ------ ...... Distance to near st: Well -------- SP_-------------- -----Foundation -------to_-------- Prop. Line __s___...:________ LEACHING LINE No. 'of Lines --------11---.-------- Length of each line--------.5 ------ Total Length -----S S..!.............. . 'D' Box k ----- Type f=ilter Material ---- Depth Filter Material ---l_5F----------------------y---_--,_-.- I' Distance to 'nearest: Well -----_-_-5�_-.ol_____"- Foundation ----_/.h___________ Property Line. ----47_____________ SEEPAGE PIT ( ] Depth -------- --.- -------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth ---------------------------------------I---=----Rock Size -------------------------- Distance to nearest: Well ---------_------------------------------Foundation ---------------------- Prop. Line ........................ REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------`--------- Date -----------------_.. _.----------) �. rr. Septic Tank (Specify Requirements) ------------------- ------------- - --------_-----_-•---- ---------- ---.<_-------------------------.. Disposal Field (Specify Requiremt ents) --------------------------------------------------------------------------------------------------------------------- --------------- - ----------------------- (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 toorkman's Compensation laws of California." Signed - -------------- Owner By ----------------------------------- Title ✓ -'C '_c/'i• -------------------- 'f (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------------------------- DATE --------------- BUILDING PERMIT ISSUED - ------------ ---- ---------------- -----DATE - ----------------------- ------------------------------------- ----------------------- - ----------------- ADDITIONALCOMMENTS -----------------I-------------------------------I--------I-- ------------------------------------------------------------------- ---=--------------------------- t ., ---------------------------------- j - --- - - - --- Final In by: ___ _ ____ Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M