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' FOR OFFICE USE: j APPLICATION FOR SANITATION PERMIT ---------- -- --- - ---------------------- --------- - - - r ` -� (Complete in Triplicate) Permit No,. ------------------ - 5� 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -------�(� J ], - ----lez----CENSUS TRACT ------------------------_ ' Owner's Name C / ---------------------------------------------------- ----------------------Phone ------------------------------------ Address -------------------------------------------------------------------- ------------------------------•--- City _.`r1I----------------------- -•--.--- Contractor's Name -----/C� ----------------------__---------License # ( :1 Phone- i�--- Installation will serve: ResidenceA Apartment House❑ Commercial :❑Trailer Court C] / Motel ❑Other -------------------------------------------- Number of livingunits:___f.-____ Number of bedrooms _ _-_-------- I _.___Garbage Grinder ,E��_ Lot Size ��«t.ZyP Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private,' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay-Loam.1] rdpan,0 Adobe ❑ Fill Material ------------ If yes, type ---------------------------- f (Plot plan, showing size of lot, location of system in relation to- wells, buildings, .etc. must be placed on reverse side.) p, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is°available within 200 feet,) N + PACKAGE TREATMENT { ] SEPTIC TANK D1Size__/ _ _/_r ___ _`_______ Liquid Depth `__-____,_____ d Capacity Z _�,:__ Type�f`� Material GNo. Compartments ----�------_------- V Foundation _ ___ Pro line .461a -- Distance to nearest: Well _ - --{�----------------------- ---- p. -----.--.•- LEACHING LINE No. of Lines ----- ------------- Length of each line_ _ �.._ �-*-�-- Total Length __ f/ D' Bo?eto --- !F_ Type Filter Material/ Depth Filter Materidl _� Distan nearest: Well R____________ Foundation pQ-___--______ Property Line SEEPAGE PIT Depth _ ------ Diameter J?3___-__ Number ___-. ----------------- Rock Filled Yes No 0 Water Table Depth ------- ------------------'-----------Rock Size J-7 ---------------------- _ Distance to nearest: Well __. _©___ _________________Foundation _ --------- Prop. Line _._ ----- (Prev. Sanitation Permit# --------------------------------- ---------- Date _________________________________) Septic Tank (Specify Requirements) -------- ------------- ------------------------------------------------ ----.------------------,.------------------ -------- i Disposal Field (Specify Requirements) ----------------- ----t-------------------- -------------------------------------------------------------- --------------- --------------------------------------------------------- - ----------------------------------------------------==---------------------------------------------------------------------------------------- en (Draw existing and required addition on reverse side) i I hereby certifythat 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 td Workman's Compensation laws of California." Signed ---`- -------- ----------------- ----- Owner -------------------------------------- BY ' Title --- /� ------------------------------------------ ----- --------------------------- is other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----W._- - `-44----fttic--------------------------------------------------------------- DATE --IP_)-'9• A-9 --------•-------•- BUILDINGPERMIT ISSUED -----•- -------------------------------- .................. ........ -=--------------DATE ------------- ----------------------------- ADDITIONAL COMMENTS £ � �=- --------- ----------------------------------------- FinalInspection by: --------- -- -------- -------------------------------------------------------------------------------------Date ----- �o io r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M. -:-� {