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z r, OR OFFICE USE: •lab APPLICATION FOR SANITATION PERMIT /o`6 Permit No. / f (Complete in Triplicate) ----- -------------------------------- Date Issued This Permit Expires 1 Year From Date Issued ---------------------- 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 ma is rd' No. 549 and existing Rules and Regulations: ` --- CENSUS TRACT ----------------------------- . - , JOB ADDRESS/LOCATION f d o-- -- Owner's Name -. " _. . -- ------ - -------------------------------------------------- - --------------- -Phon ----- -------------------- ` ,-- rh ` City ' r Address -" � - - Contractor's Name ._.__-`�' --- '` - ""�"'� °T__-.License # Ie�d ." __ Phone . Installation will serve: Residence �r4artment House-E] Commercial .❑7railer Court ❑ Motel ❑ Other -------------------------------------------- a F Number of living units:------- --- Number o� bedrooms V""---Garbage Grinder ------------- Lot Size ------------------ ------ ----__-- Water Supply: Public System and name ---------- "____""-_--------------- -- Private 11- ---------------------------------------------------------- -- Character of soil to a depth of 3 feet: Sand'q it❑ Clay E] Peat El 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.) r1 ' NEW INSTALLATION: 1No septic tank or seepage pit permitted if pudic sewer is available within 200 feet,) ` s PACKAGE TREATMENT [ ] SEPTICTANK;� ! Size ,2"--�"_?--X.---"-------------------- Liquid Depth ____.--------.----- Capacity Typel - Materia --0- 6-.t Compartments .__..._.,.--- x - h r r' Distance to neare :`•Well -":____-�--------------------Foundation __/ __ __________ Prop. Line ______:__._-:-- .�� LEACHING LINE [+]' No. of Lines ------5R------- '- Length of each line---/_-qd-- ------------ Total Length -----=-----•-----------•-•-- 'D' Box - ___ Type Filt6r Material -___ _�Z_ -Depth Filter Material """11- ------------------.-�----------- Distance to nearest: Weil ,��-"""___„_---Foundation'-__/0=.�----,__-_Property Line i W' 1111— .= Rock F'irl led ye s 'g3'� � No ❑ SEEPAGE PIT Depth ----I!P- j Diameter ------- Number -------- ” - Water Table Depth ------------ -------------=--------Rock Size 4�-fe -------- i .ionI Q Prop- r1 Line Distance to nearest: Well __-__ ____""" � _"_ Foundat REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------- -----------:- `- ---- Date it ---------------------------------- -------- ----_---- -t----------------- ------ - -- -----)- ----------------------------•--------•- Septic Tank�(Specify Requirements Disposal Field (Specify Requirements) -_----.__" ( ------ --------------------------------------------- ------------------------ -------------------------- ------------------------------------------- _- i (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." Signed -------------- ------ Owner BY ------ --- r . . . ........ Title -----�------------------------ (If other thFno, nerjj-- - FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---r -------/C�C?- f�G rc1------------------------------------------------ DATEQ.-"--S------ - BUILDING PERMIT ISSUED -------------------------- , -----------------=------- DATE ----------------------------------- ( f"_ - ADDITIONAL COMMENTS z_` •)�-- - �} 'C j t - -f--- -------------- - --- ---- -------- € ------------------------------- ---------------------- ---------------------------- -- ---- -------------------------------------------------------------------------------------------------------------------------- -------------------------------- ------- - - ----------------------------------------------------- -- --------- Final Inspection bY: -------.." d ----------------------.Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M