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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT =-------------- " Permit No. __7�-_S (Complete in Triplicate) ---------=----------- - -- ---- - - Date Issued ___________________ _�. _._. ___._____ 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: .rte JOB ADDRESS/LOCATIOx' C�- J = ----'�4ENSUS TRACT --------------•----------- Owner's Name ------ -Phone------------------------------------------ Address ----------------J` City Contractor's Name ___________- .'Y cR—__-� /if. License _I'll` _ _ Phone ��1Y�?r'I Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number ------------- ---------- - - - - --- --- - - - Number of living un its:-----�- Number of bedrooms __....Garbage Grinder A___ Lot Water Supply: Public System and name ----- .......... ----------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Jk 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.) 11 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ` Size--- k_l.4__. _____ Liquid Depth ___ . .r........... Capacity,.,2_11s1__G_'RL Typp� a _&_ Material_.[`' No. Compartments _44 to nearest: Well /I�ld___ 'cJ--Q �.___-_Foundation 1/[J_-_r__________ Prop. Line ------ -�`.-•---- LEACHING LINE ' No. of Lines ___o ________________ Length of each line__-, 5`�`� _________ Total Length _r `' ._.__...__._ 'D' Box ._ _-__ Type Filter Material 1 -------Depth Filter Material -___�� `�___________________-._._ Distance to nearest: Wellll__ !- � Foundation rQ__/-___________ Property Line .-�................ __� , SEEPAGE PIT �' Depth �,TS___--______ Diameter _ _�__�_--- Number ___-_--.01 �_____-_--_-____ Rock Filled Yes, No i Water Table DepthG rr -----------------------------------Rock Size ------------------------- Distance to nearest: Well -ek--Q---- -O-------- � ® r --_-__-- Foundation _fid___--__-_-- Prop. Line --�------•-----_--- - --_ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -_______-_- _____---_--_-_________) SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------•------------•-----•.------------------------.-- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------- ---------- ------------ --------------------------- - ------ ------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 hereby certify that 1 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 Workman's Compensation laws of California." Signed ------------ Q ------------ -- Owner By -------- --------- 'G - `L- Title --------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 7— < t ------------------`- --------------------------------- DATE _ BUILDING PERMIT ISSUED - ------------------------------------------------------------------------DATE ------------------------------- ----------- ADDITIONAL COMMENTS --------------------=-------------:--,- � - - ..._ __ ___ _ _____ _____ _ __ _ ___ f `7 -- _ _ -_____ .--_--____ _---__-_____-_ --. -_____--___. -__---___- - - - - ----- ------ - -- 1 r- -may -:----- ---------------- Final Inspection by: ----------------------- r '` - • Date -- - -- -� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M