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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT F- . V Permit No. ------------------------------------------------ (Complete in Triplicate) ---"--""----"--"-- Date Issued -' -'�-L 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: y2� -------------------CENSUS TRACT ..------------------------ JOB ADDRESS/LOC ION . - --- = � ,F +�`-` �` " Owner's Name --- ` --------------------------------------------- -------------r--------------I- --Phone ------------------------------------ Address CityLj?°�� 1 �= �` ------------------License Phone'-' Contractor's Name ______ __ ---------------•- Installation will serve: Residence O(Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- Number of living units:-_ ----- Number of bedrooms�_-_..__Garbage Grinder--4P-- Lot Size ` Water Supply: Public System and name --------------------------- -----------------------------------! Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam f 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 tarok`or seepage-pit permitted if public sewer is available within 200 feet,) _ Liquid Depth ------------------r PACKAGE TREATMENT [ ] SEPTIC TANK Size- --- --- - q p ��'' Material_ �/ `'_-- No. Compartments " Capacity A�✓�-�-,�-----_-- TYpe�/_f` ---- �`=""=---•----•---- . - f ,� Prop. Line -716F........... Distance to nearest: Well ____/�! ------------------Foundation _,/- - - LEACHING LINE ] No. of Lines ____'� _________ Length of,each line-_ --- Total Length //`h1 J. ----------- ''/ -__.De Depth Filter Material 'D' Box j/4-�P---- Type Filter Material/ fe p f �i Foundation Property Line a-47............ Distance to nearest: Well� -�- ---,- � SEEPAGE PIT P ' Depth --- Diameter JJ? J?----- Number/41 _ _ Rock Filled Yes�tf No Water Table Depth ----- ----`�----------------•- -- ----Rock Size "' �%�' _ ..Foundation __-- --- Pro line .. ---•----- Distance to nearest: Well _____.�-�,�'---------------- �� --- p' REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------=-------------) Septic Tank (Specify Requirements) --------------------------------------------- -`"------"-"""-""""'---` Disposal Field (Specify Requirements) ------------"------------"--•------------------------------------------------- -------------------------------------- ----------------------------------------------------------- -------------------------------------- ------ ---------------------- - - ------------------------------------------------------------------------------ (Draw existing and required addition on reverse side) 1 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 Rurs 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 Workman's Compensation_laws of California." Signed ---------------------------,r -- ------ Owner BY --------------------------------- --- _ , Title ".�*v ----------------------------- (If other owner) FOR DEPAItTMENT USE ONLY �co� /Q,G� ----------------- DATE © 7 L' APPLICATION ACCEPTED BY __-_______-__ ------ Jif BUILDING PERMIT ISSUED --------- -------------- --- ---------------------------------- DATE ADDITIONALCOMMENTS ------------------------------------------------ ---•-----------------------------------------------------------------------------------------..--------------.. -------------------------------- ----- 1---- -------- -- - ------------------------------------------------------------- ------------- ------- 14--------r \ ---- -- ---- ------------------ ---- 1 ---\. 4-1- ----- ------------------------------------ Final Inspection b - --- ---------"--`"------�------�" -----------------Date --- ------ a� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M