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b . FOR OFFICE USE: -� APPLICATION FOR SANITATION PERMIT Permit No. �, ,r (Complete in Triplicate) = ------ ---------------------------------- Date Issued 6-/� -- ----------- --------------_---_----. This Permit Expires 11 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. 9 ------ -- -----CENSUS TRACT --------------•---------•- JOB ADDRESS/LOCATION ------ Owner's Name --- fl-1� ''Af" ��' �1' i�ff. ' --------------------- -------------------Phone---------------------------•-•------- Address ----- ,7Ze-A,-E-f,0-017------------_-• City -S-X� --------------------------------------- Contractor's Name -- -, -- •�-- - -----------------------------.License #`a ----2Phone _ l� �>�� D --- Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:---- Number of bedrooms _____Garbage Grinder g- Lot Size _ ��-------------- { Water Supply: Public System and name ---------------$---------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt o Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ Adobe 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,) (-t PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid .Depth -----------------------_- Capacity ---_- ----------------_-Capacity ----------- --- Type -------------------- Material---------------------- No. Compartments -------------- Distance to nearest: Well ------------------------------------Foundation _.-------------------- Prop. Line ----------_--_--..---- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line________ __________________ Total Length - ----------------_-- V Box ------------ Type Filter Material-____________________Depth Filter Material ------------------------------------------•- Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ------------------ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number _-------.------------------ Rock Filled Yes C] No 0 Water Table Depth = ---------------------Rock Size -------------------------------- f IN Distance to nearest: Well ------------------------------------------ Foundation -------------------- Prop. Line ---------------_---- REPAIR./ADDITION(Prev. Sanitation Permit# -----------------------------------------=-- Date ---------------------------------- f--------------- ---------------------------z.-----------------------_--- Septic Tank (Specify Requirements) ------------------___-_- Disposal Field (Specify Requirements) --- V- ------------ 1��- jl ---- Jel W ")- .0" --------------- ------------------------- --------------- -------------------------- - , , � {Draw existing nd requi ed addition o reverse sidW I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Mules 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 ------------------- -- -- ------------ ------------------------------- Owner By ----- �f! ' --------------------- ...... --- Title ---- _/ ------------------------------------- (If of than owner} I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ vim• ----------------- ----- DATE BUILDING PERMIT ISSUED DATE ----------------- ------------------ "' ADDATIONAL MMEN�=--_--- --��---�---�-------�------------ - ;--�"�-�- -- �-_ �'-11 _ --- - - °"�►- ------- ------------------- -------------=------- Final Inspection by: ------------ ---------------- ---------------------------------- .Date tom SAN JOAQUIN LOCAL HEALTH DISTRICT �_ E. H. 9 1-'68 Rev. 5M.