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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .Permit No. 7-�7�----r�----� - s --- -- -- (Complete in Triplicate) i Date Issued --Z�Z------7 v # ----- ------ This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District fora permit to fcns%truc and install the work herein t described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: i `5 JOB ADDRESS/LOCATION ._.� --51-�7------�-------�_ _ _1l�-S �'lC CENSUS TRACT --"---- ---------- �1��'5------d��-U-5� - ------------------------- -------- ------- ------ ------Phone /,..��----��•�---------- Owner's Name --- ------- City .,�waol------------------- -------I- --' -----------------------------------------------CCa Phone !,z'� � Contractor's Name _._ .-__-- e S i L License # C��_ - Installation will serve: Residence}? Apartment House❑ Commercial ❑Trader Court ,❑ Motel ❑Other ----------------------------------- ------- z�_----Garbage Grinderd---- Lot Size -_��-- - - Number of living units:-:_/--- ---- Number of bedrooms _- private �] Water Supply: Public System and name ---------------------"-_--- ------------------------------------ Character of soil to a depth of 3 feet: Sand.❑ Silt 0 Clay ❑ Peat❑ Sandy Loam;X Clay Loam F] ' Fill Material ------------ If yes, type --------- ------------------ Hardpan ❑ Adobe ❑ . buildings, etc. must be placed on reverse side.) [Plot plan, showing size of lot, location of system in relation ermiitedof public sewer is ava;lable within 200 feet,) NEW INSTALLATION: (No septic tank or seepage p p �/ Size_ --- -- Liquid Depth _� -------------•----- PACKAGE TREATMENT [ ] SEPTIC TANK W, Size ------------ ' �, o. Com artments a�---------------- Capacity/900 raw Type rMaterial p f r �--- Foundation ,0--i---------- Prop. Line --5- a9 Distance to nearest: We11 -___------------------- Q / Total Length LEACHING LINE No. of Lines ---- --------------- Length of each fine_ --��----- �h ��'f------ 4,11 --... -'D' Box -- Type Filter Material ----Depth Filter Material _PQ---- ----- Distance to nearest: Well �p0------- ------ Foundation f�---r------------ -- PropertyLine-jr_-----------No ❑ SEEPAGE PIT ` [ ] Depth Diameter ---------------- Number -------------------- Rock Filled Yes ❑ ------------- Water Table Depth ------------------ -------Rork Size _ ° Foundation -------------------- Prop. Line ---------•------ --- ` Distance to nearest: Well ------------------------ REPA{RfADD1TION(Prev. Sanitation Permit ---------------- j Septic Tank (Specify Requirements) -------------------------------------------------------------- Disposal Field (Specify Requirements) ---------------------------------------------------------------------------------------------- --------•--------------- ------------------------ - ---------- -------- ---- -- - - =- - - -- --------- -- i ------------------------------- ------------ (Draw existing and required addition on reverse si d e) 1 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 perfor ante of t e work for which this permit is issued, I shall not employ any person in such manner as to become subject to Vel rkma ompen ation laws of California." Signed ----------------- - --- --r------------------------------- Owner ---- --------------------------- -- Title - - BY ------- -------- {if r than wner) } . DEPARYMENT USE ONLY =y =7 APPLICATION ACCEPTED BY � - ---- - - ------------- - -- ---_.-.--- --------- -------- --. DATE ------ / - --- - -- ----�--------- -------- -------- --------DATE ---- -------------------------------------- ISSUED -------- ------ ------- ------------ BUILDING PERMIT ISSUED ------ -- -- -- - ADDITIONAL COMMENTS .--- - ------------------------- -------------------- - ----------- ---------------------------------------------- -- ------------------------------------ i ---------------------------------------------- -----Date ---- ------------------- -- -- ----------- -------------- Final Inspection by: ------- -------------------------------------- N JOAQUIN LOCAL HEALTH DISTRICT F. H. 9 1-'68 Rev. 5M