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FOR OFFICE USE: IAACp APPLICATION FOR SANITATION PERMIIT -- f -- ------------•- �, Permit No: �--- =------ (Complete in Triplicate) --------------------- ------------- ------------------_-------------------------------------- This Permit Expires it Year From Date Issued Date Issued ! A. �f• 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 ADDRESS/LOCATION ----- ------------------------ -.- CENSUS TRACT ------------- -------- Owner's Name ---Af 1-____/-------`-- Q IST 5--------•--------------------------------------------------- -------Phone ------------ Address - JAddress 51% ---------. City - T�l " �iC% ......__ e Contractor's Name -- � ___. __ __ __ 77_ _1..3----- Phone -- ---��-�-�F - -----------------------License # � -- -- Installation will serve: Residence]Apartment House❑ Commercial :❑Trailer Court P❑•- 1 " Motel ❑ Other --------------------------------------- --- u: 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❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ p Hardpan ❑ AdobeZ Fill Material ------------ If yes,type ------------------- ----------- [Plot,plan, showing size of lot, ocation of system in relation to wells, buildings, etc. mustbe placed on reverse side.} NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) q,"'-� : PACKAGE TREATMENT [ ] SEPTI TANK, -.. Size-- 4/ /�S!--=---------------- Liquid Depth --y `.----.--- - ---•--------------- :,. Capacity ��__ Type �l�,f_�-. Material�c�L�No. Compartments - N I Distance to nearest: Well -__-,,' `CJ- ---------------------Foundation ...lk-............... Prop. Line __S'---____:•.--_--_ LEACHING LINE fja No. of Lines -------- --------------- Length of each line.------ Or'- Total Length ----— Box .W'--_- Type Filter Material XQc%-------Depth Filter Materia --- Distance to nearest: Well --5` -`-------------- Foundation -°_-------------- Property.Line. --- '-.-_-.__.-------- c, SEEPAGE PITT Depth -- .5_-........,. Diameter _____-- Number 1__________________ Rock Filled Yes No i❑ �.. Water Table. Depth /Q - �� ------- :' --------Rock Size A-V Distance to nearest: Wel! -------------------Foundation -1-A------------- Prop. Line .. - _-_-...__.- REPAIR./ADDITION(Prev. Sanita"tion Permit# ------------=_------------------------------ Date ------..--------------------------) Septic Tank (Specify Requirements) =- ------------------------- ---------:---------------- ------ Disposal Field (Specify Requirements) =----------------------- ------------------------ ---------- ----- ----------------------------- ----------------------------- ------- ---------------------------------------------------------<------- --------------------- ----------- -------------------------_------------------------------------------- ----------------------------------- jDraw 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 erformance of th work for which this permit is issued, I shall not employ any person in such manner �, has to become subje/than 's C pensation laws of California." ► Signed .--------- -- -----�--------------------------------------- Owner # I ------------ Title -------------------------------------------- ------------ -- I f other} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- ------------------------------------------------------------------------ DATE ---- f/ ' -------- BUILDING PERMIT ISSUED ------ ----- - - --------- --- -- ---- ------------------------------- --- DATE ..-- -------------------------------------- ADDITIONAL COMMENTS .II - � ��--------- --- ----- ---- ------- ._"'---------- -- -- -------------------/c/ 40 C ' ---------- Final.lnspection bY- ---------- ---- -------Date -- _ SAN ,JOAQUIN LOCAL: HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M