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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT G -- ------------------------ ----------------------------- r (Complete in Triplicate) /Permit No. _____---------------------------------------------- b. --------------------- --------------- This Permit Expires 1 Year From Date Issued 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 _-- .--- - i �� ✓t_ ----- -CENSUS TRACT --------------____________ Owner's Name ------------------------------------------- -------------------Phone --------------------------•--------- ;— -,--/, Address �._7 �f2_ ,ff11 j------------ --------------- Contractor's Name -L� r .�_/__ Fd__ cc�£ '�-,- ?--- License #- �7- _ Phonef�_ ?.p- � � installation will serve: _ Residence.-Apartment House-[:].Commercial 17railer Courl j:j Motel ❑ Other -------------------------------------------- Number of living units:---f - Number of bedrooms -_-------Garbage Grinder ------------ Lot Size _____ .. Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ]] Y. -- Hardpan ❑ Adobe Fill Material ------------ If yep,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,) PACKAGE TREATMENT { ] SEPTIC TANK:( Size____• _X_'S`?�ea,1,j_C ____ Liquid Depth ___�£-2---_---.----- Capacity -0--4'-C�-----_ Type �_ S Material_- Q-iNo. Compartments ---�_..__--__.__. Distance to nearest: Well ------ 5_0--------------------- ---%0------------- Prop. Line _________ LEACHING LINE [ ] No. of Lines -----J---------------- Length of each line____ ------ ------ Total Length �....___.__-_ ' f Z <. 'D' Box 6�---- Type Filter Material l_ 1L ___Depth Filter Material ----X?_-_____..----------`___....__-.. t T� Distance to nearest: Well ___ _--------____ Foundation .__2�9,-__.--,._____ Prroperty Line--;;.?---.-. --.--- 10 SEEPAGE: PIT [ ] Depth -------- Diameter —.53------- Number -_.__-_ _ _ ----------------- Rock Filled Yes U�— No Water Table Depth ---------4- -r-----------------------------Rock Size -- X__�- /�-=----- o - Distance to nearest: Well _--ZI)0— Y: Distance __/0______�____ Prop. Line ___�------------- REPAIR/ADDITION(Prev. Sanitation Permit C# -------------------------------------------- Date ----------------------------- I SepticTank (Specify Requirements) ------ ------------ - -------------------------------------------------------- --------------------------------------- -------•-••- Disposal Field (Specify Requirements) ------------------- ------- --------------------------------------I------ - - - -------------------------------------------------------------------------------------------------------------------------------------- (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 ect to_Workman's C mpensati.on laws of California." Signed Xl =----------------- Owner 1 _ By --------- ----- -- - ..�. - --- Title 4-� (If oth an owner) -�� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ` " f ------------------------------------------------------------ DATE __ - :�C BUILDING PERMIT ISSUED ---------------------------------------------------------------- - -------DATE --------------------------------------- - - ------------------------ ADDITIONAL COMMENTS ------------------------------------------------------------ -------------------------------------------------------------------------------------------- ------------ --------------------- ------------------------------------------------------------------------------------------------------------- ------------------------------ ---------------------------------- - ------ Final Inspection by: ---�------------------------------------- ----------------Date .. SAN JOAQUIN LOCAL HEALTH DISTRICT .E. H. 9 1-'68 Rev. 5M