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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r Permit No. 7-2-------------- - ----- _--- ------------------------------------------------ (Complete in Triplicate) 1 t Date Issued -�_--/3- 7a/ -------------------------------------------- ---------- 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 described. This application is made incompliance with Co u Ordinance No. 549 and existing Rules and Regulations. ' .-"--- ----- - ----- ----- JOB ADDRESS/LOCATION ------CENSUS TRACT -------------------------- ` - -Phone ------------------------------------ � �-Owner`s Name - - --•------ --- --------- -- - ------ -- --- ----- - - Address --- / �_./ - City -- -------=----- - ---- t �� ._� �_ --- Phone License -"--�� ---- Contractor's Name ._------ -- - ------------ ------- Installation will serve: •- -�----Y-�Residence- = artment House❑ Commercial:❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- Number of living units:.--..-_ ._ Number of bedr .. `�-------G rbage Grinder��--- Lot Size - � ------- -------------- ---- [�� Private ❑ Water Supply: Public System and name ------------ ---- - ICla Peat E] Sandy Loam ❑ Clay-Loam E]. Character of soil to a depth of 3 feet: Sand❑ Silt 1 ' p Hardpan ❑ Adobe: ill Material ------------ If Yes, type ---------------------------- .. v jPlot 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 ------ ----• ] -------- Material-- -------- ------- No. Com artments ------ ---------- Capacity ----- -------- --- Type --- �---- --------- Distance to nearest: Well ---- `------------------------------Foundation ---------------------- Prop. Line ----------------- LEACHING LINE No. of Lines _-.-.__-------------- - g Len th of each line-------------- ----------- - Total Length .-------------_------------ [ ] 3 D' Box ----- _ -- Type Filter Material -3_.:-ti-----------Depth Filter Material =-------------------I---------•--------••--- -Distance . -------- -- SEEPAGE PIT [ ] Depth ------.-------------- Diameter ------------- -- Number Rock Filled Yes E] No �❑ Water Table Depth ---------Rock Siz'----------------------- 1 2 to nearest: Well ----------=---------_---_------_- Foundation y Prop. Line --•------------------ .j ''1 ,. Date ----------------------------------} REPAIR/ADDITION(Prev. Sanitation Permit e# -------------------------------------- ------------ -- - - ----- -------------------*------------ Septic Tank .._-_--.---.------------- -- --- SepticTank (Specify Requirements) ------------------------ -------------------------- t-- --- ----- -- / ti ]�� Disposal Fiel pgSify Req irements) -------- l - i ----- ------ -------------------------------- - (Draw existing d-stin an : 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 4oaquin Local Health District. Home owner or licen- sed agents signature certifies the following: r "I certify that in the performance of the work for which this permit is is sued, I shall not employ any person in such manner as to become subject to Workman's Com en3ation laws-of California."- O ner Signed --------------- f / '---------------- Title U (!f of a ner) FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY B --- ------ ---------------------------- DATE ----------------------•------------------- --DAT ---------------- --------- -------- ------- BUILDING PERMIT ISSUED -- ADDITIONAL COMMENTS --------------------------- ---- ----- ---------------------- ---- ----------- Date - v� -------------=---------------- ---------- --- Final Inspection by: -- --------=-------- ---- ----------- SAN J AQUIN LOCAL-HEALTH DISTRICT F H_ 9 1-'68 Rev. 5M