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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� ------------------------------------------------------- Permit No: (Complete in Triplicate) I - ----- This Permit Expires ] Year From Date Issued Date Issued _._�_�a Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatio''A is d -n com�fiance with ounty Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION12k :___� _ .____ 0� � _:-_151 <__ _ -_. ---------CENSUS TRACT _____ __._ f Owner's Name .--- -- = ----- �� ,. , -------- ---------- ----- �- - ----- ---- --------- ------Phone 429_4----------------------- __4M " 9.?i---- - Address ------- — ------ -- City? Contractorp.'s Nome - _ - ----License # 1 �' 7 Phone Installation will serve: /Resid ce [Apartment House,❑ Commercial:❑Trailer Court :E1 t Motel ❑ Other ' Number of living units:_-_,_ Number of`bedrooms _-_ ....Garba_ge Grinder Lot Size --- __ ____________-_ Water Supply: Public System and name ------------- --- X""r-- . _____Private _ = - Character of soil to a depth of 3 feet: Sand'❑/lift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.E] Hardpan Adobe❑ Fill Material----t------- If yes,type _________.___________-___ 4. x i (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 see ge pit permitted iff public sewer is available within 200 feet,) SEPTIC TANKSize- -- -�_I�_J___�C_-5-- v PACKAGE TREATMENT ii. 'V r r r { ] '[ ------ --- - -- Liquid Depth ._-�-_------------.-•_-- Opacityp'Z -- -- Type -- }- _ Material --- ------- No. 1 Compartments --- Distance to Weare t: Well -------------9',a__ _ ________________Fouadation ___- _P__r___________ Prop. Line _4............... LEACHING LINE [ N'o. of Lines __._______� __._ __________ Length of each line _. _I_e�............ Total Length ----- -U"______________ D' Box ._ .____._ Type Filter Material _ __t'_ __-____Depth Filter Material ---1-1J___ ______________ iN. � Distance to nearest: Well -------5'a---------- Foundation ------La__`____.____ Property Line_ ___s________________ ___._ Diameter ____ ��- Number �' _.__a_._.__ Rock Filled Yes No SEEPAGE PIT [ Depth -----j:;:2 _-- ----__ �❑ �i. Water Table Depth -------------------?o------------------------Rock Size ------------ Distance to nearest: Well _______________ ?_fl__`_____________Fouhdation _____LA--------- Prop. Line .__.--�[___-____ --- Septic Tank (Specify Requirements) ------------------- ------------------------------------ ---------------------- ) REPAIR/ADDITION(Prev. Sanitation Permit# ________________________________ Date i. V- ------ Disposa� Field (Specifyl�jRequirements) ------------------------------------------------------ -------------------------------------------------- - ------- ------ . '� I ------------------------------------- ---=-------------------------------------------- -------- -------------------------- ----------------------------------------------1------------------------- --------------- ------------------------------------------------------------------------------------- ------------- (Draw existing and required addition on reverse side) } I hereby certify that I ha:e 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: k "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." Signed --------------------- --- -- - --------- Owner ' BY -------------------- -- -.--------•- er .n> ---------------- -----•----- ---- --------------�---------�------------- Title -------- ---- ----------------------- -------- {If other than owner) lr .; FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED �BY ----------------------- --------- ----------- ------ -- DATE`------------------------------------------- BUILDING -- v--3--��--------------------- BUILDING PERMIT ISSUED----------- ___DATE -------------_--------____ ADDITIONALCOMMENTS' --------------- ----- ------------------------------------------------------------------------------------------- ----- - i - --------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- -------------- ------------ -- -- k -- - --------- d Final Inspection by: --------------------------------- ------------------------------- Date�_`_ -- �7V- -- JOAQUIN LOCAL HEALTH DISTRICT r E. H. 9 1-'68 Rev. 5M-ii