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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. -- -f-.- - -- , --------------------------------------------------------- i ---- This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made in compliance with County Ordinance Na. 519 and existing Rules and Regulations: I JOB ADDRESS/LOCATION _43-3- --c -.......... ------ - '- ----��----------------------------CENSUS TRACT ------�-----•----------- h e � Owner's Name -------------------------- ---------------------------- ---------------------------------////�-------------------Phone ------------------•--•-------------- 4 Address �_�.�-��a,--, ----`s--------- ------ •--------- - -�_� city -- ------- --c�`�=,''-.' --------------•---------------------... Contractor's Name ----- r - ---- ---- ----- --- 7�- ��+r-ts``- ------License # _�8 '_Y._ Phone Installation will serve: Residence ❑Apartment House 171 Commercial' Trailer Court ;❑ . . Motel ❑Other .-- --- - -- ---------------------- i Number of living units-------=_ Number of bedrooms '--___-Garbage Grinder Lot Size --------Sel_e J______________ Water Supply: Public System and name ----------------------------------------------------------------------------- -------------- -----------------Private [q"� ? Character of soil to a depth of 3 feet: Sand'[:] ilt)] Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe [] Fill Material ------ ----- If yes,type ---------------------------- (Plot _____________________ _(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,) A. PACKAGE TREATMENT [ ] SEPTIC TANK:[&� Size__.5__1<_g_ ------------------ Liquid Depth ____ ___________________ W Li Capacity 00-LoU Type _ ___ Materiai_QW� No. Compartments __G�_____________ Distance to `nearest. Well ------------------------------------- p _--Foundation----L_o__________-- Pro Line _4---------------- LEACHING LINT; ( No. of Lines _________/_____________ Length of each'line________440----------- Total Length :_____q6__.............. 'D' Box ____________ Type Filter Material ------S__R-----Depth Filter Material _,______ly 11_ ____________!________..___ j Distance to nearest: Well ______St?_--- Foundation ---------116------------- Property Line _------_________________ SEEPAGE PIT [°f Depth ___s _'.�_-_____ Diameter ---�.q,.� Number _____-_.C________________ Rock Filled Yes Na C] Water Table Depth ---------- --- ------------------ Rock Size -�f�-----'r-3- ------ !� Distance to nearest: Well ------------1. 0_-________________Foundation -----)_ D_f_____ Prop. Line ____ ........ REPAIR/ADDITION(Prev. -------- ----------------------------------- ---------------------------------_) i Sanitation Permit# Date Septic Tank (Specify Requirements) -------------------- ------------------------------------------------------- --- ------------------_-•--------------------.::_ Disposal Field (Specify Requirements) -----------------------------•--------------------------------------------------------------------------------------- ------ ---------------- --------------------------------------------- --------------------------------------- -------------------------------------------------------------------------------------------------- ------------------------- ----------------------- --- ----- ------- --------------------------------------------- ---------------------------------------------------------- ------------------ (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 i ` as to become subject to Workman's Compensation laws of California." Signed --- --------------------------------------- ---- ----------- Owner i --------- 1 P =------- Title .-- --- ------------------------------------------------------------ r (If other than owner FOR DEPARTMENT USE ONLY N APPLICATION ACCEPTED BY __. _. ------------------------------------------------------------ DATE -_71--------------------- BUILDINGPERMIT ISSUED --------- --------------------------------------------------------------------------------=--------------DATE ------------------------------------------- ADDITIONAL COMMENTS ________________________ ------ --------------------------------- --------------- ------------------------------------------------------------------------------------------------------ ------------------- ------- -- - - - - - ---------- Final Inspection by: ----------------------------------•---------------------------------------Dateze _1 7 --- i' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M