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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT. (Complete in Triplicate) --- ----- --------- Permit Na. --7- --�-�-•_ ��} --------------- This Permit Expires 1 Year From Date Issued Date Issued Application is'hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describedl,jThis apphi.cation is made in compliance with County Ordinance No. 549 and existing Rule i and Regulations: JOB ADDRESS'/LOCATION ---- 1 . CE NSUS TRACT-------------- ------ -------------- Owner's Name _ -------Phone._ Address .� C Contractor's Name ____ License #62/ 6 ---- Phone cf�! _ � _��----- ----------- - ' Installation will serve: ,. Residence,❑Apartment_Nousey___Commercial-_; Trailer Court ! ❑ ❑_ . _❑.� _.k Motel ❑Others.-!' ► 4`y1�! L - --•-- -- Number of living units------ _ Number of bedrooms _______Garbage Grinder _.______-_ Lot Size ______I_- ------------------------------ Water _ 1. - ------------------------- Water Supply: Public System and name•_y__________________ __ - ' ---------------;--------------•-----•-- -Private ❑ - - ------------------------ -- Character of soil to a depth of 3 feet: Sand'% Sift❑ Clay Peat❑ EJ Sandy Loam ;[] Clay Loam ❑ � 1 r r4 i Hardpan ❑ Adobe-❑ File Material ------------ If Yes,type ------------- ------- r (Piot 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 permittedif.public sewer is available within 2b0 feet,) PACKAGE TREATMENT { ] SEPTIC TANK } i Size------ .� l ------------ --=--------------------- Liquid l4epth -- •--.----- Capacity -..... - ” Type -------------------- Material -------- No. Compartments Distance to nearest: Well ----------------------I-------------Foundafaon ---------------------- Prop. Line ----------------_----- ` LEACHING LINE [ ] No. of Lines 'A------------------------ Length ofach line-----'`v`-✓---.---------- Total Lenith ------------------•--------- O 'D' Box ----------.�}Type Filter Material �" � I � I �t - Depth Material` r •------------ -•---- Distance to nearest: Well'----- _________________ Foundation ,,. --- - ------------- -Property�, Line --------- --••----•----- ..� SEEPAGE PfT k c -_ ._ ---- - � [ 1 Depth - -----�- Diameter -_�_ ._._ Number.....,_____,--_ 4} Ji ,idled . Yes ❑ No ❑ � } Rk Water Table Depth '----.- --- ock Size --------------- Distance to ne i_ .-�f - ---------------------,.Foundation t_J_- . Pro � arest`Well _ gip. Line ------------- REPAIR/ADDITION{Prey. Sanitation Pirmitt# ---------_---------------------------------- Date 9 - -- ---- Septic Tank (Specify Requirements) --------------------------------------------------- -- = f Disposal Field (Specify- Requirements) --------- --------- ------------- #tri -- -- -------- --------------- ----------------------------------------- r - ------ -- -r i% ------- ------ --- ---- ----- � a�.� __ ___ ______ _____ ----- ---- - --- ----- ---- - {Draw existing and required addition on reverse sia'W " y I hereby certify that I have prepared this application and that the ork will-be done in accordance with San Joaquin County Ordinances, State; Laws, and Rules and Regulations of the San Joaquin Local Health District, dome owner or licen- sed agents signature certifies the following:___,: _ '-`"� i-" - --^= --��-= »- --..�---•. , "1 certify that in the performance of the work for' 'hich thisipermit is issued, I shall not employ any person in such manner as to become subject✓ man" C mpensation laws of-California." {'t x;., Signed-_ C. t �.—� �_ � , Owner Y-- By. --------------- ------ :.- --------- t Title - --.----- --- (If other than owner) FORDEPARTMENT-USE_bNLY...,,._.�•„� .. BUILDING PERMiT 15SUEp _ - � _J__ j Y APPLICATION ACCEPTED BY 1.__ - DATE --- _ _' -�_ ---•---- ADDITIONAL COMMENTS _.________._ -- --- - -------------------------------------- ---•-------------------------------------------------------------------------------------------- -------------------------------------- - ------ ----------- ---------- ----- Final-Inspection-by. -- --,----- -=�f '�._ -_ -_-------- ------------------ � ------------------- ------ - --------------- --�=--------__:�-__:.__�.-,�._.------�------•----=--..__.Date_-----�-'..=.-�-��.:��-��---- -- _ SAN JOAQUIN LOCAL HEALTH DISTRICT � � . E. H. 9 1-'68 Rev. 5M - '.