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FOR OFFICE USE: - - APPLICATION FOR SANITATION PERMIT -g„/ - --------------- Pen o. (Complete in Triplicate) ------------- ---------------.___-_______________- 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO J�TION ` �_ ___ / LV .____�I' __..____________.---.CENSUS TRACT __ _'` '___----- f ` -+� Owner's Name .- --------------------------------------------- --------------- Address ---( - .�. �_11y10rVC�tltdd f�12 City L'y' ' �2 Contractor's Name __ #'��____ �/tom __:__--_.License # --- --- ----- -- ----- - Phone _ /`L�'� - -- - --------------------------------- Installation will serve: Residence [� Apartment House,❑ Commercial O<Trailer Court ❑ Motel ❑Other -------------------------------------------- Number of living units_____________ Number of bedrooms --____--___Garbage Grinder ------------ Lot Size � -------------- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private (� Character of soil to a depth of 3 feet: Sand;M Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material __________ If yes,type ---------------------------- (Plot _-__.___________________(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 --------------. -_______-__-_--___ Material______:__-___-____ No, Compartments Distance to nearest: Wel _______________________________-__Foundation _______-_--_______ Prop. Line __,_________-________ LEACHING LINE [ ] No. of Lines ._-_____ ------- _-_ Length of each line_______________-_---___-_ Total Length -________-____-____-______ 'D' Box __-__-____ Type Filt r Material ___________________Depth Filter Material ________-____--__-_-__--__-_______-______ Distance to nearest: Wel ________________________ Foundation Property Line ______-___._ SEEPAGE PIT [ ] Depth ___________________ Di eter _________-____ Number __________________________ Rock Filled Yes '❑ No i❑ Water Table Depth ----- -----------------------------------------Rock Size -------------------------------- Distance to nearest: We I ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# _ __ _____ - Date __________________________________) Septic Tank (Specify Requirements) ---I4/V��"II_______J-60-a---- -'C'--------------- Disposal Field (Specify Requirements) /�..________�_ i0A1 . -Pt�__-_ ------ ----------------------- -__-_ r -- ---------- ------A-SID------------3+g Q `- =-------- 1Draw 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 Workm 's Compensatiqn laws of California." Signed ____ ------------ _ Owner By --------- -- ----- Title --------------------------------------------------------- ---- - ---------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ' ----------------------------------------------------- DATE -= --; BUILDING PERMIT ISSUED . ---- -------DATE --------------------------------- ADDITIONAL COMMENTS --- ---•---------------------------------- -------------------------------------------- --------------------------- -------------------------------------- -- - --- -- -- Final Inspection by: . - ---- -- ----- ------------------ ---- -------Date �a7 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM