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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> / q� ------------------ <br /> (Complete in Triplicate) Permit No. <br /> -------- ----------------------------- ------- <br /> - Date Issued <br /> *' This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District foo a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOC 1 N .-.� " t <br /> - CENSUSiTRACT -------------------------- <br /> Owner's Name --------------Phone <br /> - ---------- ----------- <br /> Address S `� -a. City <br /> --- <br /> Contractor's Name -.- <br /> _License #cr1- Y-7-3---- Phone 7_ ---------•----7"---•- <br /> Installation will serve: Residence ❑ Apartment House-E] Commercial railer Court ;❑ p� �� <br /> 4 Motel ❑ Other -------------------------------------------- <br /> Number of living units_____________ Number of bedrooms ----------._Garbage Grinder _---------- Lot Size -------------------------- <br /> -------------Private <br /> Water Supply: Public System and name ------------------------------ --- ------------ - <br /> ------------ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt E11.-Clay. ❑ Peat E] Sandy Loam -C] Clay Loam [I�.rt <br /> Hardpan ❑ _,Adobe Fill Material ____-___ _--- If yes,type ---------------------------- <br /> . .», �.�... . _ .A t I <br /> r......,1 �.;J ; <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) \1 <br /> NEW INSTALLATION: (No septic,tank.or._seepage pit�permitted,if public sewer is/available within 200 feet,) �j// � Q <br /> SEP�Z4?�Type <br /> %�C�'.l`_ ----__---- Liquid Depth ___T------------- ---- <br /> PACKAGE TREATMENT I ] ize__ ______ <br /> Capacity � 8 - Material_ No. Compartments ---- ------------•--- <br /> .1 ` r <br /> ------Foundation _� ------ ---- Prop. Line <br /> Distance to nearest: Well ------}--------- r <br /> LEACHING LINE No. of Lines --------/--------- g each line----- ---------- Total Length --- , ------•--------- <br /> Length of` ---De Depth Filter Material __� --------•------------ ---------- <br /> D' Box ___________ Type Filter Material �_ � p f � <br /> r Foundation Property Line -•- <br /> I -,-Distance to'nearest. Well/—­ <br /> ell _./. - "----= -' ;� <br /> , "'_/— ­ <br /> ..____ Number --____.__�_ - _-- __ Rock Filled Yes° r No <br /> SEEPAGE PIT � i Depth _,�_�- -- Diameter ,., <br /> Table` Depth .-_____- ---------- >` <br /> f--------- -Rock Size _ - -------------- <br /> Water , <br /> Distance to nearest: Well ___-- - --------T <br /> Foundation _-%--.- ---- Prop. Line-. -------- • . <br /> REPAIR/ADDITION(Prev. Sanitation Permit#�--- ,,,m„---� — -. I <br /> Septic Tank (Specify Requirements) -------------------------------- ------------------- <br /> •' <br /> Qi <br /> ' sposal Field (Specify Requirements) ----------------------------------- <br /> ____________________- ----•--- ----------------------------------------------------------- <br /> ---� <br /> ------------------ <br /> ------------------------ ---------------------------------------------------------------------------------------- <br /> i (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local r <br /> sed agents signature certifies the following: - - <br /> Health District. Florae owner or licen- <br /> i "I certify t at in the performa of the work for which this permit is issued, I shall not employ any person in such manner <br /> i as to b _ e s �e t to rk n's Co en i laws of California." <br /> Signed ----------------- -- <br /> Ow <br /> ', ^"'------- n e r <br /> nTitle -------- ---------------------------- ---------------------- ----------- <br /> BY ------------ - (Ifo other er t <br /> (If othan o <br /> FOR DEPARTMENT USE ONLY <br /> --------- -------.--------------- DATE _.I l <br /> APPLICATION ACCEPTED BY DATE _.._ <br /> BUILDINGPERMIT ISSUED -------- ---- ------------------------------------------------------------- <br /> ADDITIONAL COMMENTS ---� ------ . - - <br /> ---------------- ---------- ----- <br /> ------------ --------- --- ----- -------------------------------= = -,----------------------------------------------- <br /> -------- <br /> . .. <br /> Final Inspection b <br /> ---- ---------- - ------ <br /> ----- ''f•�z=------------ - -- --------Date _. ----�-- --r.------ -- - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M - _ <br />