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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ --------------------------------------------------- (Complete in Triplicate) Permit No: --- --------------------- _--------- ---------- -------- ----------------------IN--- Date Issued -------------------------------------------_______ This Permit Expires 1 Year From Date Issued i 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 in compliance with County Ordinance No. 549 and gxisting Rules and Regulations: f �� .. JOB ADDRESS/LOCATION 1;r4l --'� / 1ENSUS TRACT --------___----------- --- Owner's Name --- - �= lt --------------------6 Phone Address --- ----r�}-o-c--- .. ------------------------------------------------- City Contractor's Name .--- -.---�s� - / _- tf-,P `c __--.�-_License # --„ ;;2-,S-5Z/.VPhone installation will serve: Residence ❑Apartment House ommercial ;[]Trailer GurtI ;❑ Motel ❑Other ------------------------- --------------_-- Number -- _Number of living units:---/------- Number of bedrooms __Z_-__Garbage Grinder ------------ Lot Size --- - XZ!��S--------------- IM Water Supply: Public System and name--------------------------------------- ---------- --- --------------------.-------------•-------------• ...Private Character of soil to a depth 1Mof 3 feet: Sand ❑ Silt E] Clay Peat❑ Sandy Loam ❑ Clay LoamEl 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: (Nio septic tank or seepage pit permitted if public sewer is available within 200 feet,) } PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth --------------------------- e,,(o -------------------,--.--e,,(o 'r�C, Capacity -------------------- Type -------------------- Material------------ --------- No. Compartments ------•---------------r t Distance to nearest: Well ---------------------------__----__Foundation ---------------------- Prop. Line ---_-_.._`-_--__-._--� Ir LEACHING LINE [ ] No. of Lines -----19-1--------- Length of.ae�ch line.----'� _ Total Length -----leo-------- -- --- D' Box tom!_- TyOe'Filter. Materiel =`�-C-X.�r�__Depth-'Filter"Ma'terial _--- -------------------------------- Distance to nearest: Well_ /f� -tom_ -- Foundation �7 ---------------- Property Line - -.---_-__-._____ �r--_ Number x �_-.._.---- _ Rock Filled Yes No SEEPAGE PIT [ ] Deppth ---o2�_-°----- Diameter --- ,-------------- - ---; -- ' � orn $_ Water Table Depth -�---- 10.x--`_----------- . -Rock Size--f- &X-1__4�Z------- _,0( � �1 P Distance to nearest: Well__-_--- i.--------_-_-.:Foundation --�Q---------- Prop. Line ._ ..-..._-.._. r Ddte ------------ -------=-------------) O REPAIR/ADDITION{Prev. Sanitation Permit S#-.?--------=-------------------------------- - � Septic Tank (Specify Requirements) ------------------------------------•-------------------`--=----------- ' , Disposal Field (S Retirements) F ------- ----- - -----"'""'J x --- --- ---------- - : , ............ -------------------------------- ---------------------- 44JJ i( raw existing and-requir d dd-ition-on reverse side) - I hereby certify that 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 becom su lett to Workman' Cat ensation laws of California." Signed -- - [ - ----- -- --=------: Owner BY --��- - Title }- ------------------------- (If other a ner) ” ' F .��. OR .bEPARTMENT 175E ONLY 4. ' APPLICATION--A---C--C---EPTED i3 ____ .r_ I� �� .�-f -- ' ---------- ---- ----------------------- DATE __ ..` . BUILDING PERMIT ISSUED----__._ ------------------------------ ---------- DATE ADDITIONAL COMMENTS'I---- --------------------------------------------------------------------------- --------------------------------------------------------------•------------------ • - ------------=---- -------------- -- -------------------------------------------------------------------------------------------------------------- i----- ------ ------- ----- ----- ----- -------------------------- Final Inspection by E --- = ------- ------------------------------------------i - ---------- ---------------- ---- I -------- ----- --- Date -- = SAN JOAQUIN LO AL HEALTH DISTRICT ((( E. H. 9 1-'b8 Rev. 5M,1