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FOR OFFICE USE: •" r APPLICATION FOR SANITATION PERMIT {Complete in Triplicate} � -- - Permit No: Date Issued L!'--_c�_ :-7D ----------- _U_----__---_-___ This Permit Expires i Year From Date Issued 4 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 Count A9r dinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-- - ---l-�_ --,--- �� ; C.------------CENSUS TRACT _- " - Owner's Name ---------------Phone Address --_1_L-2rf- - ---- --- -------"- -- -- ' ---------------- --------- ------------ Cit Contractor's Name -- Hx '?�' Phone 0,. LJ _-------- cense ..- Installation will serve: Residence�Apartment House❑ Commercial ❑Trailer Court :E] Motel ❑Other ------------------- ------------------------- Number of living units:------ ----- Number of bedrooms ---3-----Garbage Grinder ------------ Lot Size ------ -------------;; Water Supply: Public System and name -------------------------------------------------------------- __Private El- - ----------------------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat Sandy Loam 0 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 seepa a pit permitted if public sewer is a ailable within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK'[ ] Size-- ----------------- ------------ - ----- Liquid Depth -------------------------- Capacity ------- ----------------Capacity -------------------- Ty e -------------------- Material------------------ --- No. Compartments Distance to nearest: Wel ------------------------------------Foundation ------------------ --- Prop. Line --___------_--_._____ LEACHING — ------------------- --- Length of each line---------- - LINE [ ] No. of LinesLh - --- -_-----_-- Total Length ------•----•----•-••--------.,� f 'D' Box ------------ Type Filt r Material __-----------------Depth Filt r Material ----------- __ ----------- •---------- Distance to nearest: Well ----------------------- Foundation --------- --------- Property Line ---__--_ -.------------- SEEPAGE --- -SEEPAGE PIT [ ] Depth --------- Dia eter T _ -___ Number ...--- �`1 Rock Filled Yes J No 0Water Table Depth --------- ---------------------------------------Rock Size - - ]. ----------------•------ Distance to nearest: Well ----------------------------------Foundatio -------------------- Prop. Line --------__----------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- --- Date --_----_-- ---) " Septic Tank (Specify Requirements) -------- ------------ ----------------- Disposal Field (Specify Requirements) ADD-----` ------E�_ISTL 1J�___S,y5TzM- P - ` ------------ -- �. --- ----------- __ (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." Signe --------- ------ Owner ------------- - BY = -------- Titled (If other than owner) �� FOR DEPARTMENT USE ONLY } APPLICATION ACCEPTED BY FOR ---------------- DATE -- � " p BUILDING PERMIT ISSUED -------- - -------- -- --------DATE - --- -------------------------- ---------------------------------------------------------------------------------------------- - -- ADDITIONAL COMMENTS -- ----- --------- - - -- --------------------- SAN ------------------- - -------------- ---------------- - ------------------------------ Final In Spec ---- -- - - ---- -- ------------- -----------------------------------f Date ------l�'I -- ' ----------------- � ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H..9,# J-'68 Rev. 5M e