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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------- ------------------------ ------ Permit No. .(Complete in Triplicate) ----------------- ---------------------------------- CE Date Issued --------------------------- 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 _ «__., - � tl ��lT�1�1T--/- �f 'CENSUS TRACT _-__-----_____.___--_-.--- Owner's Name ------ � ---------Phone ---------------------------------- Address ---_ -- Address ----0. ----------------------- City - Contractor's Name .-- _-� f, E----------------License # -` �7� ---- Phone - C>—s Installation will serve: ResidenceXApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- f Number of living units:--/------- Number of bedro ms -�___}Garbage Grinder -------- ... Lot Size _A40 ----__-_______- Water Supply: Public System and name ------------ Ls/ --L�-----------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat ❑ 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. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) pt PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth _______________---------- F\' Capacity --------------------- Type -------------------- Material---------------------- .No. Compartments ------•---- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --,.___________--__._- d LEACHING LINE [ ] No. of Lines �� ---_1-_-_-_ ------ Length of each line-___.Z�------------ Total Length _._1247------------- 'D' Box(_c!t ---.- Type Filter Material ---.Depth Filter Material -----/J9------------------4r_------- ' {i Distance to nearest: Well ___�P�t-------_ Foundation -__ Q_.___-_----- Property Line ___ __________________ r r� ' SEEPAGE PIT [ ) Depth _._ -- ----- Diameter --. ------- Number --------/-- -------------- Rock Filled Ye No C] Water Table Depth -------.!�a'�-------------------------------Rock SizeK $` r Distance to nearest: Well ----- _________________Foundation _C!?----------- Prop. Line ---------------------- REPAIR/ADDITION -__ _________-REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 Septic Tank {Specify Requirements) --------------------------------------------------------r------------------------ - ,-�-- �--- I Disposal Field (Specify Requirements) r;; 'G@ am 'r- `,`•"- z � U /' - - fc�- .fir ---------------------- ` -------------------------------- V (Draw xisting and required acUtion 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 suk 6cto Workman's-Compenlption laws of California." Signed =_ '�`u'c� '`---- r By ----- -- --- -------- ----------------------- (If ---------------- -��~ -Title - (If other than owner) �r F R DEPART T SE ONLY 6 17 APPLICATION ACCEPTED B DATE ... .. ........ L BUILDING PERMIT ISSUED ---------------------------------------------�------------------- DATE - ADDITIONALCOMMENTS ------- -- --------------------------------------------------------------- ----------- --------- --------------- - ----------------------------------------------------------------------------------------------------- - --- - -------------------------------------------------------------------------------- ---------------------------- - -- ---------- ------------- ------- - ---- ------------------------------------------ -- --- - ---------- ---- ---- ---------------------------------------------------- -------=- ---------------- - - -- Final Inspection by -------------------------------------------------------------------------------Date ------ � ��-- - -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M