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i s FOR OFFICE USE: ri APPLICATION FOR SANITATION PERMIT Permit No.. - --------------- --- - --------- ----- --------------------------------- {Complete in Triplicate) Date issued .�-- -��?� r. 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/LOC TION .__��--�-- - - - --- - -- - -------- Owner's Name .- �} `34.4- - ----------- • --------------------------------- - ------ Phone- aS C' Address �� . - City . - �y7� ' ------ n -- --�---_--------- - Contractor's Name --------------- o. ------------.License # -5 /73-- Phone -- �—------------------ Installation will serve: Residence ❑ Apartment House❑ Commercia1.0Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units_____________ Number of bedrooms ------------Garba_ge Grinder ------------ Lot Size ------------ Water Supply: Public System and name----------------------------------------------------------------------------------------------------------------Private,' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay El E] Sandy Loam f:1 Clay Loam ❑ t Hardpan ❑ Adobe' Fill Material ------------ if yes,type ____________________________ W �I (Plat plan, showing `size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) `E NEW INSTALLATION: (No septic.tank or seepage pit permitted if public sewer is available within 200 feet,) , PACKAGE TREATMENT { ] SEPTIC TANK'[ ] t" Size--- v2-`z!_,d___, --------------- Liquid Depth ---�-------------• Qp --- 5'----------_ Capacity _ _____._ Type -L- -------- Material_-� ------ No. Compartments ry _ , Distance to nearest: Well --------5-Q______________i------Foundation --------- Prop. Line LEACHING LINE No. of Lines ______ _'-_.____ Length of ea line_____ ______________ Total Len th _-4/41___-.______._____ . :, - g 'D' Box --_____-.__ Type Filter`Material _- d '.Depth Filter Material __--� -------=------- r c Distance to nearest: Well _=_, d_______f,__ Foundation ____-15-4----------- Property Line. + _- -________-_.... SEEPAGE PIT }' Depth ___r�_�------ Diameter _ 3________ Number _____-___ _______o/____ Ro.1 olck Filled Yes �" No ❑ Rock Size _6R.-Y-3---------------- Water _ € � Table Depth ------�4-----------;--------------"----- - � k Distance to nearest: Well ___1jV' --------------------------Foundation _ 0__:______ Prop. Line __ _-._--------- REPAIR/ADDITION{Prev. Sanitation Permit# -------.---------------------=----------''---- Date ------------------------- -- e Septic Tank (Specify Requirements) -------------------------------- -----------------------------------------••- ---------------------------------------------------------- -- - Disposal Field (Specify Requirements) -------------------------------------------- ---------------------------------------- ------------ -------- II--��€y._. .�� .. � �------------------------� =------------------------ -------------------- required ad ------------ ---- - ---- (Draw existing and q - addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance.,,with•Son 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 bec su ject to ork n's Compens ion laws of California." t Signed --- ----- -- ------------ , -------------- Owner ---------- -Title -------- ------------ --------------------- - -------- -------------- (If other than o ner) L� t P ENT USE ONLY ' APPLICATION ACCEPTED BY --------- - - ------- --------- --------------------------- DATE --�/�7r BUILDING PERMIT ISSUED ------------- DATE -------------.----------------------------- A---D _IT ONAL COMMENT - --------- ----- -- ---- ---- ---- 7- ------•--- - ------ ---- � �► u - --- -- k T` kf : = -/ meth � ------------- - --------- ------------- - rY � � ------------ -- -T----- _ � ---------- Final I spection by: -- ----- -- ----- - ------------------------------ - --- --- -------------------Date AN OAQUIN LOCAL HEALTH DISTRICT t EL H. 9 1-'6B Re M _