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EOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' Permit No�3---- -' (Complete in Triplicate) t --- ------- Date Issued _ �5-7 - -- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 l-� ----�' �✓ - __ CENSUS TRACT --------------.-••-------- Owner's Name (� 1 ; ---------- Phone Address 3 -----------•--- City ------- Contractor's Name --------------- --- - License # _f� // -- Phone __ -__-- --- ------ ••- -j A Z Installation will serve: Residence jApartment House❑ Comrcial :❑Trailer Court i[] - t _ .Y•_ Motel ❑ Other ---------------------1--------------------- l Number of living units:_____C____ Number of bedrooms - -.Garbage Grinder ___ ____ _ Lot Size ---- ---- f Private ❑ Water Supply: Public System and name ----- -------------•------- - ---- --------•------ - ----- - ---------------------- Character of soil to a depth of 3 feet: Sand'❑ Silt F] Clay [�] Peat E] Sandy Loam ❑ Clay Loam❑ r Hardpan ❑ Adobe ,` Fill Material ____________ If yes,type ----___.___________________ \ V (Plot plan, showing size of lot, location of system in relation toi wells, buildings, etc. must be placed on reverse side.) Lnl NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �0 PACKAGE TREATMENT SEPTIC TANK:[ ] Size-------------------}-------------------------- Liquid Depth --------------------:.---- (CapocitY ----------------- Type -------------------- Material---------------------- No. Compartments --------------- Distance to nearest: Well -----------------------'------------Foundation _.__ ` "_`3__ Prop. Line -----------..:.----•-- l` LEACHING LINE [ ] No. of Lines ------------------------ Length of each _line- `-------------------------- Total Length ----------.----------------- r D' Box ------------ Type Filter Material ------------------ depth -Filter` Mifteria1� :- Distance to nearest: Well ___- ____�___ _a^_-�_�-----•----------------•----•- "------ Foundation` ------VA'11'---------- Property Line ------------ ----------- -_ SEEPAGE PIT [ ] j Depth ____ Diameter ----- NUmber1LI ==1-- Rock Filled --Yes--[D- No WaterTable Depth ------------------------ -------------•--;-----Rock Size -------------------------------- - --------------- _ --- __ ---•. r --- -- Foundation ----- Prop. Line ( Distance to nearest: Well __________________________ _ REPAIR/ADDITION(Prev. Sanitation Permit+ --�---- ----------------------------------- Date ------- .- ---------- ------- --------- ) Septic Tank (Specify Requirements) - ----------- ----------- 3 1 ---------------- Disposal Field (Specify f2equirements) ------- = - - ------ --------------- ----------------------------------- ------------ '.-----�--------------=�3 �� S^ � ��-----�f--- �°--=------------------------------- ---------- I --------------------------- - - -------------------------------------------------------------------------------------=--------------------------------------------------- (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 Rulesani! Regulations oof-the Sari 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 .- t.r-Title----------- (If other an owner) ( Q r. FOR .DEPAitTMENT USE ONLY APPLICATION ACCEPTED BY ----- ---, DATE ------- ------'r--------- -- - ---- ---------------------------------------------------------------- BUILDING PERMIT ISSUED ----------------- ---- ----------- DATE ADDITIONALCOMMENTS - ------------------------------ ---------------------------------------------------------------------------- ------------------------------------------------- -------------------------------------------------------------------------- ------------------------------ I -------------------------------------------------------------------------- --- --- ---------------- ----------------------------------------- -------------------_---------- - ----- --- - --- ------ --- ----------------_----------------------_------------------ -�� ___ _ _____________ Final Inspection by: ---- -•------Date - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M