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r FO,OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------- Permit No. _ _L'----�----�---y ------- --- � --- (Coit7plete in Triplicate) S - 1 Date Issued -------------------- 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: JOB ADDRESS/LOCATIO _ '--L�- -- _PJ---------------------------- CENSUS TRACT - ---- ------------ ------- Owner's Name - Phone ----- Address �- City -- Contractor's Name --- ' ---- _ ----------------------.License # J1 471/-------- Phone . -- - ------------ Installation will serve: Residence)�Apartment House❑ Commercial ❑Trailer Court C] Motel ❑Othpr -------------------------------------------- Number of living units:------ -_- Number of bedrooms ___,_____Garbage Grinder _._ _____ (Lot Size __-_�-�---- x---� -------------- Water Supply: Public System and name _____________-________ Private E] Character of soil to a depth of 3 feet: Sand'❑ Silt[I Clay E] =Peat-E] Sandy'Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Mate-ial ------------ 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------------------- ---;-- • ----------- Liquid Depth -------------------------- Capacity ------------------------- Ca acitY ---------- ------ Type -------------------- Material-------- h------ No. Compartments ------------ -----•--- NK Distance to nearest: Well ------------------------------------Foundation -------------------- Prop. Line __________----------- LEACHING LINE [ ] No. of Lines ------------------- ---- Length of each line.-------------------- ---;-----Total Length ------------------- -------- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------------------•------ `� Distance to nearest: Well ________________________ Foundation _-__.__.------------- - Property Line ------------------------ 7� SEEPAGE PIT Depth --- Diameter ________________ Number ------------------------- Rock Filled Yes ❑ No (:1 it WaterTable Depth ---------------------------------------------_Rock Size -------------------------------- Distance to nearest: Well -------_-----------------------=---^---•-Foundation -------------------- Prop. Line -_------------------_ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________-_--------------------.-} Septic Tank (Specify Requirements) ------------------------------ ---------------------------- ------------------- Disposal Field (Specify Requirements) ----------42,dd- - 7---0------- r ------------------- --------------- - ------------- "xz� - ------------------------------------------------------- -------- - ------ --------------------------------------------------------------------------------------------------------------------=------------------------ ----------------------- (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 --- ---------- ------------- ------------- { -------- BY ------------- -------------- lfother_t owner) FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ----------------------- ---------- -------------------------------------------------- -------------- DATE __7_W BUILDING I- BUlLDING PI=RMIT ISSUED _ - DATE -------- ----- - ------------------------------------------ ADDITIONAL COMMENTS ---------------- ---------- - ------------------ _ -------------- ------------------------- Date- -- -- _ -- __ _ --------- -- - - --------- Final __ _ Final Inspection b -- - P Y' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M