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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 ------- ---------------------- ------------------- Permit No. - ____ (Complete in Triplicate) ! ------------ ------------------------------------- Date Issued - �Y- -- 4._-. 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 a ; described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �r -----------CENSUS TRACT -------------------•------ JOB ADDRESS -Z- ----f ----� ---------- ------ -------- F -- --- Owne�'s Name t�-� Phone f, --- -- - Address f- .- ----• Cit - ------------ ------------------ ------------------ ------------ -- --- --- -------- v Contractor's Name 7i_L —,License # 1d3 ' Phone \ ion will serve: Residence ❑ artment House❑ Commercial ❑Trailer Court ❑ \ Instal lat ; Motel ❑O#her '1'�k`- ---- '` — - _ - -U�-e-er-- - Number of living units:____�____�Nur'siber of-bedrooms __r...Garbage Grinder .____.._.-__ Lot Size _-..___ ___'______________ _ Water Supply: Public System and`name ----------------f+---- -- ---------------------------------------------------•---------Private {: Character of soil to a depth of 3 feet: Sand❑ ' Silt❑ Clay E] Peat❑ Sandy Loam Clay Loam ❑ Hardpan F] Adobe ❑ Fill Material ------------ If yes,type ---------------------------- v (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,) r PACKAGE TREATMENT { ] SEPTIC TANK Th Size_____ __ _ _____ ________--,e._...- Liquid Depth --------- --------- Capacity *-Pp-ca----Type _ =d_ Material? --- No. ,Compartments -----`----.- Distance to nearest: Well .------- =- f Foundation ---/ ----- Prop. Line _.._.5. ------- LEACHING LINE { ] No. of Lines ----------I------------ Length of each line-------iVqff= ______ Total Length /--V---0---____...__ i. 'D' Box Type Filter Material ----S_Rt..Depth Filter Material -----f- ----------------------------- Distance to nearest: Well ------ ------ Foundation ------LC--r-__..__. Property Line ________________________ j ljl-`? ' F _1 a -- Number ------ ---- -------- ---- Rock Filled Yes 1] No I❑- [ Depth -----� -------- �-DraT mt'er - i- f Water Table Depth ----------- I A ----------------Rock Size = .0 ---�-=---------- ----- ---- ----------•--- r f r r Distance to nearest: Well ----------------to! -- Foundation ---_-- F'-- .---- Prop. Line ___-- ------------ REPAIR/ADDITION(Prev. Sanitation Permit F# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) -------- --------- - -- ---------:---------------- •---------------- .1 ------------------- Disposal Field (Specify Requirements) ------------ -- ---- --------------------------------- ----- --------------------------------- ----- --- - -------------------------------------------------------------------------------- 1 (Draw existing and required addition on reverse side) E 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 -.b------------------------ - -- --- Owner -- --- - -- --� By ------------------------------------ `L7 hL�` Titlee- - r =---------- ------------------- (If other than owner) FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY _-- -- -'- ,Jr -- - -------------------------------------------------------------------- -----------� DATE ._�= --�--- ---------------• -------- BUILDING PERMIT ISSUED ------ -------------------- ------DATE ----------------------------------------- ADDITIONAL COMMENTS - -------------------------- --- ---------------------------------- -------------=----------•---------------- ----------------------- ------------------------ ---------------------------------------------------------------------- -------------------------------------------------------------------- --------- - ---------------------- ------------ ----------------- ------------------------------------------ --------------------------------- ----------------------------•--------------------- --------- -------------------------- - ---- - -------- ------ ------ ------ ------- ---------------------------- l�r -------- ------- Final Inspection by: ---�-- -- ---------------------------.Date ---- - ------------- --------- -- -- ----- ------ ---- - --- -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M