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i JOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------ --r---------------------- Permit No. F {Complete in Triplicate) ------------------------ ----------- This Permit Expires 1 Year From Date issued Date issued Application is hereby made to the So Joaquin Local Health District for a per 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 ADDRESSAO ATION - --------- �1�� L' 1 "'L'= --------------CENSUS TRACT -------------------------- Owner's NameP 4-rJ- P.-J3 -------------- _ Phone .. Address ------------------- -J7 y, �C�` `w'TY `dr _ Contractor's Name - 1 � `� License # �- Phone Installation will serve: ResidenceP3-Apartment House❑ Commercial ❑Trailer Court l❑ Motel ❑ Other -------------------------------------------- Number of living units:--------- Number of bedrooms -----Garbage Grinder _._ ------ Lot.Size ____-______-______________________________ Water Supply: Public System and name ----------------------------------------------------------- ------------------------------— ••---y-------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ lay [:] Peat E] Sandy Loam -E] Cla Loam Hardpan E] Adob Fill Material _ d 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),�� [n PACKAGE TREATMENT [ ] SEPTIC TANK S"ze____ /h- -- lam. ,- -_ . Capacity -- - ------------ Type -trZ---- - ---- Material. ti�c�� No. Compartments --- '.......... w t I Distance to nearest: Well ---------- ------ ----------Foundation Prop. Line . .. ..:........ LEACHING LINE No. of Eines __ 0 r --- _._ Length of each line--�s�__ ___ Total Length ¢�- _____•__--_.-. 'D' 'Box _ 0S_._ Type Filter Material.•v -.•___Depth Filter Material ---------------_______________ Distance to nearest: Well ____ ------------ Foundation .�@______+_ _! ___ Property Line Spry ,S ------ SEEPAGE PIT [; Depth Diameter ---------------- Number _.__._�"_____ _ ______ Rock Filled Yes ❑ No i❑ r � � � i t Water Table Depth --------=�� Rock Size !/ 3-- ------ Distance to nearest'W61I --- A�__'_-___._ -----Foundation--F__._ _D.r--_ Prop. Linedr.........r.�.-_. ' REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------- Date ---------------------------------- g Septic Tank (Specify Requirements) �-- 1 ► Disposal Field (Specify Requirements) --------------•--------------------------------- -------------- ------- ------------ -----------------------------I--------------- ----------------------------------------------11---------- ---------------------------------------------- ----- --------------------------------------------- - _____________________________________________ ____________________i_____________--_-------._--_ ___________.__._____._________________-______________- 1 (Draw existing and required addition on reverse side)' I hereby certify-that-l.,have prep_ared(this application and that the work will beta a in accordance with San Joaquin County,Ordinances, Sta4'1aws,•`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 #or which this permit is issued, I shall nat employ any p rsori in such manner { as to become subject to Workman's Compensation laws of California." Signed --------------- `---------------- Owner By ------------------- q-��,, {----------------(If other than-------- r -- -. - ----- - '---------------- Title -------- - �- �-r --------------------------- (If ----------------------- - 3 i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------� ------------------- ------------------ ------. DATE '1-� ' -BUILDING PERMIT ISSUED . -------------I---------- ---------` ----------DATE ------------------------------- ADDITIONALCOMMENTS ------ --------------------------------------------------------------------------------------- ------------ ---- ------------------------------•----------- ,, -- ------------------- ------------------------------------------------ -------------•---------------------------------------------------------------------------•---•- ------------------------- Q(� - ---- --------------------------- 1------- ------------------------------------------------------ -----_------- Final Inspection by: --- -- --------------------------------------Date �' c�- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �•. � ''a ' ` '