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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT G ' Permit No: 11--' - -- (Complete in Triplicate) ------- ----- ----------------------------------- - - Issued Date �_-�-----� This Permit)Expires 1 Year From Date Issued , - - Y Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein -described. This application 's rr�pde in compliance with County*00rdinnceNo. 549and existin�anand RonJOB ADDRESS/LOC ION �- ----CENSUS TRA7-------------- ----------- -Phone -------------------------- ------ Owner's Name --- 'Address - K --------- - ---- Y �. -------------------------------------------- Contractor's Name - = 4)-�--.License # 4- r phone Instal:lotion will serve: ;Residence Apartment House-F Commercial ❑Trailer Court i❑ Motel ❑Other -------wI ------------- { Number of living units:-------___..Number of bedrooms ------------Garbage Grinder -___--.---- Lot Size ___.________"_______ __ _________________ Water Supply: Public System and name _________________ --------- ----------------------- Private ` Character of soil to'a depth of 3 feet: Sand'[] Silt❑ • Clay ❑ Peat El Sandy Loam ❑ Clay Loam El Hardpan Adobe '❑ }Fill Material ------------ If yes, type{---------------------------- i (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 seepdge.pit permitted if public sewer is available within 200 feet,) w PACKAGE TREATMENT [ I SEPTIC TANK',[ ] Size - Liquid Depth ---------------- -- No.._'Compartments ___- ------------------ Capacity _ Type -------------------- Material----- ----------- f P -----.:.--- ?,, ' Distance to nearest: Well ------------------------------------Foundation -----------_---------- ----- Prop. Line ----------------- ---.;Total ._. ------------ F LEACHING LINE [ ] No. of Lines ------------------------ Length of each line------ ----------- Total Length r 'D' Box ------------ Type Filter Material -- 3`_-------------Depth Filter Material -------------------------------------------- lit a `' Distance to nearest: Well ------------------ ----- Foundation -------------------------- Property Line ------------•---•-•----- I 4 SEEPAGE PIT [ ] Depth I --- Diameter --------- ---- Number ------------------------'---_ Rock Filled Yes ❑ No I❑ . Water Table Depth Rock Size Distance to nearest: Well -----------------------------------------Foundations-------------------- Prop. Line - --:,7 � E tion Permit# -------- ---------------------------- ------ Date----' = ----------------------- ) +'`I REPAIRfAD1?ITION(Prev. Santa Septic Tank (Specify Requirements) ---- --- ------- -------------------- -- ------------------------------------ Disposal .Field (Sp cify Requ4[ementsl _____________ ---------------- ------------ ' -------------------------- • t ------- ---- -- - - ®. `- X __ i� (Draw existing and required addition on r arse id' ,k 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 Rules and Regulations ofRthe San Joaquin Local health District. Home owner or licen- sed agents signature certifies the following: ` "I certifythat in the'performance of the work for which this permit is issued, I shall not employ any person in-such manner as to b co a subject to Workma Mpensation laws of California." Signe ------------ ------------------ Owner M --------------- - -------------------------- ----------------- Title ----119.0 - ,---------- ----------------- (If other than owner r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------------------------------- DATE '' '------------- ------ BUILDING PERMIT ISSUED - ---------------- -- ------------- -------------DATE .--- -------------------------------------- ` ADDITIONAL COMMENTS ------------------------------------ ------------------------------------- -- ---- -- ------------------------------------------------------------------------------ ---- - ----- - --- ----- ----------------- ---------------------------------- ----- Final Inspection by: ----------- Date ------- ------------ ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT k E. H. 9 1-'68 Rev. 5M _