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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. . --- ----------------------------------- ---------- (Complete in Triplicate) Date Issued _.1.1-`---_---- ------------------------------------------_--------_--__ 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 nyi,� irJ �pr}pIiepic i h o my Ordinance No. 549 and a 'sti ules and Regulations: d- i' YET 'L *� JOB ADDRESS/LOC ON - '�`"` I -� ' + ` '. [4 ------CENSUS TRACT `s- ------•---- ',Owner's Name '^ i..e.cc�J -------------- -------- --------- hone Address �- p � ---rte ----- CityG° ,* =' Contractor's Name -- . r . , ------.License # ------------------------ Phone -------------••--------------- - - --------- -- ------------ ------ -- --- -- ------ - ilnstallation will serve: Resident [Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ---------------------------------------- -- Number of I[iving units:------/---- Number of bedrooms --- -_--Garbage Grinder ----____-. Lot Size -.---CLQ = ------------- I ---••- -- Water Supply: Public System and name ----___-_-_---- Private r Character of soil to a depth of 3 feet: Sand'❑ Silt[] Clay F-1Peat ElSandy Loam 0 Clay Loam 11 ❑ w Hardpan R/ 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.] r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) O PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size-----------------------------------• -------- Liquid Depth -------------------------- Capacity --------- ---------- Type -------------------- Material---------------------- No. Compartments --------- -----•- (J 4 Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line .---------.----_---.- LEACHING LINE [ ] No. of Lines ----_____- °_____- Length of each line_____---------------------- Total Length 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------•---------------------•- ------ Property Line. ------------------------ Y s nearest.-.,Well __1`---_--___-------. Foundation -------------- p rty 4 _ Rock Filled Yes No SEEPAGE PIT [ ] Depth -------------------" Diameter, ---------------- Number --------------------- ❑ ❑ 4 Water Table Depth" ---------------'----------------------- --------Rock Size -------------------------------- ` Distance to nearest: Well -------- ----------__--_----___- ----Foundation ------- ------------ Prop. Line ------_-__---------__ i � I REPAIR/ADDITION(Prev. Sanitation Permit# -'----------------------------------------- Date ---------------------------------- .� _ ..... - - 1 Septic-Tank (Specify Requirements) -:'---- ------- --------------------------- ------•----- -- t Dis osal Fi d (Spec' y R qi cements) - C� r - h----------- ----- - ----- --------------- �`"` ------------ ---- ti's ` --- f r � ---------------------------�------------- ` ------------------------------------------- g q (browrexistin and re wired addition on reverse side) I hereby certify that I have prepared this applicatiori 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: -, , f " "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workma ' mpensati.on laws of California." _ . Signed . - _. �.� _ _. -- ._ -1�-''`^ . "` - _- � -------- �Owner 'r" ' Cld ------------------------------------ BY ------------------------------------- ------------ -- ------------- Title (If other;thian .owner)., �s # s y FOR DEPARTMENT USE ONLY ------------------- -APPLICATION=ACCEPTED�BY ------------------------ ---------------------- ------------------- DATE BUILDING PERMIT ISSUED -- --------------------------------------------------- --------------DATE -------------•----------------------------- ADDITIONALCOMMENTS ----------------------- ------------------------------------------------------- --------------------------- i --------------------------------- -- ---------- --------------- ----------- I ------------------------- --------------' -_---- -----.-------- ------------------------Datr-h -71- Final Inspection y.. ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M