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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------- Permit No. (Complete V (Complete in Triplicate) --------=----------------------------------------------- Date issued �__�_--�_d ___________________________ ------------------------ 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/LOCATION .__�erl_ - V --------------------------------CENSUS TRACT ---'s-y- ------------ Owner's Name ---------Phone----------------- ---- Gc � - tCiyAddress - ------- - Contractor's Name ___ .---------Lice nse # ' Phone Installation will serve: Residence (Apartment House-E] Commercial❑Trailer Court Motel ❑Other-------------------------------------------- Number of living units:____!______ Number of bedrooms#--------Garbage Grinder ___V Lot Size ............ Water Supply: Public System and name --------------------------------------------------------— ----------------------- --------------------------Private [ � Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy LoomClay-Loam Hardpan ❑ Adobe'❑ Fill Material ____________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 [ I SEPTI TANK1 Size✓ _.. 1rlax_5:_a ___________ Liquid Depth _ _v�__.--_-- -_--- LJ Capacity ---�-��'__-.-- Type� ---- Material---e��7�..�- No. Compartments Distance to nearest: Well _____________d�� _� ---------------------Foundation ------ -C_ --------- Prop. Line � --- No. of Lines each line______I - - Total Length __rz_�`P5-------_-.=.-.-.-.-.-.-.-_LEACHING LINE __�________________ Length of _ __________ 'D' - Box --- ------ Type Filter Material ____S__ '--__Depth Filter Material _ - Distance to nearest: Well ------So._________ Foundation _____1 d_I___________ Property Line -------------------- P �_ _ Rock Filled Yes e No i❑ [if Depth _____1 ----___-- Brameter e __er_�Q_- Number ----------- - ----------- Water Table Depth ------------ ---------------------------Rock Size 1 ------- Distance to nearest: Well ---------j_©fl_---------------------Foundation ---!-k ....... Prop. Line _---_-----.--.-------- REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) Septic Tank (Specify Requirements) --------------------- -----------------------------------------------------------------------------------------------•-- Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------- -------------- ------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----------------------- - Owner BY -i U-4 - Title - &-------------------------------------- ------------------------- other t an owner) 43 oa FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -------------------------------------------------------- DATE _ '-7./7--------------------- BUILDINGPERMIT ISSUED ---------'------------------------------------------------------------------------------------------------DATE ------------- ----------------------------- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------------------------------------------------n*---------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------, --------------- Final Inspection by: ------------------------------------------------------------------------.Date _�_Z.,'71I '� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.