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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. 72-_=_.—Y--p-. --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein I described. This application is made yin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC TION .- 2---3.0©- ------yl---- -------- ------CENSUS TRACT --- --7-- ----------- Owner's Name - q- � - ----- ------ ---- ---- -- - ------------------------- ------- Ph e Address ________________ __ /- ----- -- ---- ---- --------------- ------- ---------- City ------------------------ Contractor's Name --- ---- - ----- .License # .� _ Phone Installation will serve: Residence [Apartment house❑ Commercial :❑Trailer Court F] i Motel ❑Other -------------------------------------------- Number of livingunits:- J-------- Number of bedrooms ___ ---_-Garbage Grinder ------------ Lot Size ___-~-----------------------__-__-_-___-_. Water .Supply: Public System and name --- ------ --------- --•-------------------------------------------------------------- -•--------•--Private Character of soil to a depth of 3 feet: Sand'F-1 Sift❑ Clay ❑ : -Peat-D---- 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:,=rnust be placed on reverse side.) L4 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ! D . ---- Liquid Depth ----PACKAGE TREATMENT SEPTIC-TANK'"' Size-_�1" J' .._. .. . Capacity _ Type _ _ __ _ Material- �_ No. Compartments -------- Distance -to,near st: Well _________________J�' '^__. _____Foundation ...... _______ Prop. Line -__-_----_---_ LEACHING LINE [>t No. of Lines_` _- ------------ Length of each- line------1-Dom_'________ Total Length ,___c __�_Q............. ' Type Filter. Material -_-_S't1.3------Depth Filter Material __ __j-9 IV Distance to nearest: Well _`._...�'5'_, ____ Foundation _-----�_p�__ party Line --_--_--Jr _......_ --_--- Pro , SEEPAGE PIT [,�9 Depth ----"? Diameter -�_----"_--Number _________________ RockjFilled Yes No 0 Water Table Depth `fJ .._''__.......Rock Size ---------------- Distance to nearest: Well ----------- -- Q .............Foundation ____f_a_.i__..._ Prop. Line ____-_......._.___..-_ ---- ------ ------- } ' , REPAIR/ADDITION(Prev. Sanitation Permit#----------------------- -____ Date _________________________________;) SepticTank (Specify Requirements) ------------------------------------------------- ------------------------------- ----------------------------"I--------------------------- Disposal Field {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 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 ---------------------------------------------- ' Title ------------- ------------------ ° (If other than owner) ,FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------------------------------------------- -------- ------ DATE7-Z------------- BUILDING PERMIT ISSUED ------------------------- ------DATE -----------_--------------- -- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------------------------------------------------------------------- --- --------------------------- - ---- -- --- --------------------------------- �Final Inspection by: - Dcit SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M