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L7FORFFICE USJAPPLICATION FOR SANITATION PERMIT Permit--------------- (Complete in- p kate) p Date Issued 7=_*f--- ------- 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ,. CENSUS TRACT -------------- ------- JOB ADDRESS/LOCATION rd-G f-------------- - ----------- Owner's Name _ .- - ---------Phone _ _ .- 7-.---- Address vl? 4 City U Phone � a -�i ------------------ License _�_ ---------- Contractor's Name _---•-- --��----��-!'`~--�-�-- ----- Installation will serve: Res idences❑'Apartment House❑ Commercial 1MTrailer Court ❑ Motel ❑Other -------------------------------------------- --------------- Number of living units:_-_/ --__ Number of bedrooms __3-_--_Garba_ge Grinder ___l------ Lot Size __0-_5-5- --------�re rf Private ❑ Water Supply: Public System and name - YY t° ---------------------------------•-------------------------�-------•--- Character pf soil to a depth of 3 feet: Sand'F- Silt❑ Clay ❑ Peat Sand Loam Clay Loam ❑ ^4 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, PACKAGE TREATMENT [ SEPTIC TANK'[ ] Size-__ Q- _--, .- ------ • ----------- Liquid Depth ----5_4-4.--------- / R p ---�--•----.-- Capacity -la��d-------- Type Material No. Compartments d Distance to nearest: Well -.fa---f -------------------Foundation -.19_--------------- Prop. Line _- -----_----- LEACHING LINE [ ] No. of Lines ---------- Length of each line-____ 04---------------- Total Length _-" -•---------- 'D' Box %A4----- Type Filter Material s--� --Depth Filter Material -------I--------•----•----------•- Distance to nearest: Well _��°-- `___-_-- Foundation -------[------------- Property Line. Number ___--_---__ Rock Filled Yes L-] No SEEPAGE PIT [ ] Depth -------- --------- Diameter --- --------- - ---------------- Water Table Depth ------------------------------------------------Rock Size - ------------------------------ Distance to nearest: Well --------------------------------------------------------Foundation ------------------ Prop. Line ..---•----- ---------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- --------------------------------------------- Date --------•-------------------- ---) Septic Tank {Specify Requirements) --_.___-_ -- --------- -----"--- -------- - ---------------------------------- ----- Disposal Field (Specify Requirements) ---------------------- --------------------------------------------------------- -------------------- -------------------------------------------------------------------- ------------------------------------------------ ------------------------------------------------------------------------------- (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 subject to Workman's Compensation laws of California." Signed - - Owner ---------- - ---------------------------------------- ___ --------'---------------- Title ._ - � � a -------------- - - - - ------------------------- - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ----------------- DATE 7� ------------------------ -- - --- --- ------- - --- -- -- BUILDING PERMIT ISSUED ------------- ------ DAT ADDITIONAL COMMENTS ------------------------------------------------------------------------------ --------------• --- - ---- --------- --------------------------------------------------------------------------------------.------------------------------------- - ------------ Final Inspection b Date -- - --------- SAN JOAQUIN LOCAL HEALTH DISTRICT k E. H. 9 1-'68 Rev. 5M