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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------------- -------- (Complete in Triplicate) Permit No: ---7- ------------------- ------------------------------------ _____________________--_-______.__.._______.___________ This Permit Expires 1 Year From bale Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des ic, ibed. This application is made in compliance with County Ordinance No. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION �i , - - --- - ------------------CENSUS TRACT ........... Owner's Name _. ' _ Phone -------------------------- Address 7-` - Cit z�-- ----------------------- � ---- ----------- Y Contractor's Name ----------- A` -----� �> � '------------License.# --11FI'--•� Phone ----------------------•-• --•- Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court Motel ❑ Other -------------------------------------------- Number of living units:----1.11--- Number of bedrooms _______Garbage Grinder ----------.- Lot Size _._ ---- --- ------ _-.-__- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam 4 Clay Loam.0 Hardpan ❑ Adobe.E 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK'[ Size-"_ --------- Liquid Depth .. e � Capacity 1240 $ _ Type Material—t-6''_�_ No. Compartments --Y_____________ Distance to nearest: Well ------------ a___ __ ___-_ Foundation _..__ b_- pro Line ____ -� LEACHING LINE [� __ No. of Lines 3______:__ Length of each line-------4' ID-1U------ Total Length 'D' Box ------ --- Type f=ilter Material -------S_,_1�---Depth Filter Material ____15 .............................. Z Distance to neare/s�t: Well --------- 0--t-___ Foundation ---1._O---t----------- Property Line ---- r SEEPAGE PIT [ Depth ---- Diameter __,33 �� _ ___ Number ------------_3----------- Rock Filled Yes No C] Water Table Depth -------------- V Rock Size -- 3 Distance to nearest; Well --------�_b'q_ ------------ Foundation,,.--__10 Prop. Line --_5 / REPAIR/ADDITION(Prev. Sanitation Permit# -------------- ----------------------------- Date _.-___--____--....._-.------------) Septic Tank (Specify Requirements) --------------------------------------------------------------------------------------------------------------- ---_- 9� DisposalField (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 a work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workma Compensation laws of California." Signed -- ------------------------------- t/-------------- / Owner BY ----------------------------- �`�V Title _--- -- - ------- - ---------- -- -------- ---- --------- ------------ (If other than owner) OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --`----- ---------------------------------- ----------------------------------- DATE ------ BUILDINGPERMIT ISSUED -------------------------------------- -------------------------------------------------------------------DATE .------------------------------------------ ADDITIONAL COMMENTS ----------------------------------------------------------------- -----------------------*_1 ------------------------------------------------------------------------------------- ------- ------------------------------------------------------------- ------ - -------------- ----- Final Inspection b ems= ---- _ Date ---- ------------------------- ------------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT VQ E. H. 9 1-'68 Rev. 5M,