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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------------- - (Complete in Triplicate) Permit No: 7_/-___4_^2---.7 ------- --------------------- -------------- - -------- Date Issued -- .� __-_ This Permit i Year From Date 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 _ ��-__�--___ ' .�' / _._ Q ____-------___CENSUS TRACT _ ____.____ Owner's Name �t h �_` ��i_h11y1C!'-- ------------------- Phone Address ----------------- 4`_1-t__ Cit Contractor's Name -_---._- ----------- ---License # ----------------------- Phone ---------------------------.-- Installation will serve: Resident Apartment House❑ Commercial ❑Trailer Court 0 Motel n Other ------------------------------------------ Number of living units:- -r----- Number of bedrooms _--- I--Garbage Grinder ..___ Lot Size _________________________.__ ____________ Water Supply: Public System and name ----------------------------------------------=-------------------------------------------------- ----------._.Private Character of soil to a depth of 3 feet: Sand'❑ Silto Clay El❑ _Saridy Laam 0'. Clay Loam Hardpan ❑ Adobe '❑ Fill Materia! ------------- If yes, type ---------------------------- kA P. (Plat plan, showing size of lot, location of system in relation to wells!buildings, etc. must be placed on reverse side.) C NEW INSTALLATION: (No septic tank or seepage pit permitted if pupliic�sewer is available within 200 feet,) PACKAGE TREATMENTSEPTIC TANK Size____ __ ] li`.��X---�---------1--, -------- Liquid Depth ---- l r Capacity __.__- Type "_9,FJffaterial--_ * No. Compartments .__-_ Distance to nearest: Well __----- -----------------i__Foundation' __.�� Prop. Line ___ LEACHING LINE � No. of Lines ------- �-_-------- Length of each line.---------/ ___ Total Length ------�G�..._... I D' Box ___ _.__ Type Filter Material rRQClG_Depth Filter Material _____L_9___ _________________------___-.- Distance to nearest. Well ____ ---- Foundation -.--)------------- Property Line ----15--------------- SEEPAGE PIT Depth ___ z. ---�- Diameter ---3-S__--Number -----------�--------- Rock Filled Yes No C Water Table Depthez A --- .JZackSize ------ I Distance to nearest: Well ------ __ --------------I_Foundation ."110-------- Prop. Line ..... 15 REPAIR/ADDITION(Prey. Sanitation Permit# ____________________________________________ Date ______:<_==______________________) Septic Tank (Specify Requirements) ---------------------------------------------------------------------- !_-�-----------------------------------•-------------------------- Disposal Field {Specify Requirements) -------------------------------•--------------------------------` '_1-------------------------------------------------------------- ----------- ----------------------------- --------------------------- ----- ---- --- - -------------- ------ ---------------- -------------------- ---------- - --------------------------------- (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 Jaaquin 6callHealtlr District. Home owner or licen- sed agents signature certifies the following: 41 '_ "1 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 s bject to Workman's Compensation laws of California." a SignalJ/r//Q�J(y/ Owner BY rr ----------------------------------------------- -Title --------------------- -------r ---------------------------------------- ' (If other than owner) FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . -� --------------------= -----. DATE ---- / ---------------- BUILDING PERMIT ISSUED------- - - _---- ----------DATE.-::----->----------- ADDITIONAL COMMENTS '"_ ^ �,.} a• ♦ - ,�'• _ '-_ ----------- -A-- ----------------------`---------------- ------- ---- ---------------------------------- ---- - C _ ---------------------------------- -------------------------- ----------------------- --- ------------------------------------ ----- ----- - ---------------------------------------------------------------------------- Final Inspection by: -- _ Date 7- / - --- - SAN JOAQUIN LOCAL HEALTH 'DISTRICT E. H. 9 1-'b$ Rev. 5M a