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F x t FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------- Permit No. (Complete rn' Triplicate) t Date Issued ---------=----------------------------------------------- This Permit Expires I:Year From Date Issued ______ 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 in compliance with County Ordinance,No. 549 andexistingRules and Regulations-. LJ �/ �r Com+ CENSUS TRACT __-� --1.----------- ---------- - ------ II I JOB ADDRESS/LOCATION - '�--! / --- --••---1-- �`�� '�" 'r ' 1� Owner's Name C - l.� -- � .- -- Phone ----------------------- Address -- ----------- 4 � 4� Contractor's Name ---------� t".7 —�G-+ , '�-------- ---- --License # �s. is.-%. Phone - I Installation will serve: Residence A_A_Partment House-E] Commercial :❑Trailer Court ❑ Number of livingunits:___l-_-_ Number of bedrooms r" .101Motel F1 Other - ms ___Garbage Grinder Lot Lot Size ��--��-�•---- Water Supply: Public System and name -------------- -----------------------•-------------------------•-----------Private 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 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,TREATMENT { ] SEPTIC TANK'{ ] Size----------------------------------------------- Liquid kDepth ---------------------.---- w -Z } Capacity. •- ' -- Type -------------------- Material-----------:------ --- No.. Compartments ------ ----; = - a A ' t --y ; Foundation Pro Line ----------- --- ---- �. - Distance to nearest: Well ---________________________•-_____ Prop.- ., , € LEACHING LINE ;",[ ],•. No. of•Lines -___'__---____--- --- Length of each line---------------------------- Total Length ----------------.:..------ D' Box------------ Type Filter Material --------------------Depth Filter Material ----------------------------- Q k Distance-to nearest Well ________________________ Foundation ------------------------ Property Line ------------------ '7 �. SEEPAGE PIT ( ] Depth ______:_---._____- Diameter ---------------- Number ---------------------------- Rock Filled Yes 171No ❑ WaterTable Depth ----------------------------------------- ------Rock Size-------------------------------- Distance to nearest: Well _____________________ ____....Foundation ----------------.---- Prop. Line .-_____....__-__---.-. REPAIR/ADDITION(Prev. Sanitation Permit.# ------------ ------------------------- --- Date -----------------------------.----I Septic Tank (Specify Requirements) -__ ------ ..V_47e > 'f��`- --------------- Disposal Field (Specify Requirements) - ---- -- --- ----------- ------- ---- 4----------------- ---- ------ - ------� � 1;_? -- ----- ____ - __ — - ----------------------------------------------------- � � (Dra existing an�equd additiono�n reverse side) I hereby certify that V 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 shol[ not.employ any person in such manner as to become subject to Workman's Compensation s of California." Signed --------------------------- ----- ------ -------------------- Owner By ----------------------- ------------------- Title ----------- ------------------------ (If other t owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _. DATE ------ X_T11----------------- 1Li ------,---- --------------------------------- --------- BUILDING PERMIT ISSUED ---- ----- --------------- ►t ---------------DATE -------------.------- - ----- -- ADDITIONALCOMMENTS ---- ------,-}-�---- ------------------------------------------------------------------------------------� ----------------------------- ------ -- ------ ------------------ - ---- -- - --- - ------ - ----- - ---- - --- -------------------- ------- -- ---- - ------------ Final Inspection by: --- --- Date -_-- - �- `------------------- lam. ----------- ---------- `�------------------ ---�-------------------- ------- ---------- . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 51U1 �