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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT /• ` 3� .� ---'Permit No. ------------ L s 1(Complete in Triplicate) ----------------------------------- -- It __________------------------- 1 This Permit Expires Year From Date Issued Date Issuedl1_�_' d 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 Cdunfy Ojvnance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .__ __ --___________ __ ___- _____-_________.._. ____CENSUS TRACT Owner's Name ----------------- --- ----- ----- ------ ----------------`---------------- -------Phone .W -y--- 7-7//----- Addresslad- -------- ------=------ ------ - -- ------------------- City -- - -- - ---------------------------------- ---- ---- --- Contractor's Name---------_----------•---------Lic6nse #/I�-------- Phone �6tio___'96b7--- Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court 0 Motel❑ Other -------------------------------------------- �1 Number of living units: ---- ------ Number of bedrooms--� ----- Garbage Grinder ----- k"'_ Lot Size _I _X 7-_3 .............. Water Supply: Public System and name ---------------------- --------------`-----= ------Private Character of soil to a depth of 3 feet: Sand ❑ Silt F]Clay ❑ P Sandy°,koam ❑ Clay Loam ;❑ Hardpan ❑ Adobe Fill M. erial ____----__ If ; type ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse ,,tide.) NEW INSTALLATION: (No septic tank or seep a a it permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK o� S,----- ----- --- `1� ____ _ ___ Liquid -Depth ___ -------------- Capacity /00 Type ---f7- _ Material___ __ No. Compartments -! Distance to neatest: Well ---------- ..,1550 --------------- Foundation ----- /fa---------- Prop; Line .` ............. LEACHING LINE No. of Lines _____ "'_.--------- Length of eac line ------- AC- _.___.__ lof2d ;Length _,_,,i` .......... x� , 'D' Box ------------ Type Filter Material _____ ----- Depth Filter Material ... _ --------- _`_._--•-. ,_.. Distance to nearest: Well .._ �"r� _--_ ,Foundation --- ,_/0______----- Property Line --- ...... SEEPAGE PIT "Depth .__ . j_._. Diameter '3 --------- Number_.__.- .� _- toe k- 44ed Yes I No 0 Water Table Depth----------------------------------------I-------Rock Size /y� _6 . Y V / r —Distance to nearest: Well ------- l_:20 ------------------------ Foundation ----- /P._r_.._.. Prop. Line .....�5 . .._....__.._ REPAIRjADDITION (Prev. Sanitation Permit # __________________ -_______.___ Date ----------------------------------- Septic _______:____________.___________Septic Tank (Specify Requirements) ------- -------------------- -i------L--------------- - ---------- ----- - ---------------------------- Disposal - - -- ------ Disposal Field (Spefaify.. Requirements) a - --------------------------- ---- _I--------------------------------------------------------------------------------------- ------ n r s ---------------------- ----------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- (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 Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: , "1 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 Compqnsation laws of California." Signed------------------------- -- (---- - ---- ---•------------------------- Owner By-------------- -------- ------------------------------------------------------ Title -------- - - -- -------------------------------------------- (if other th wned FOR DEPARTMENT USE ON APPLICATION ACCEPTED BY --------------------------------- DATE ---------------- BUILDING PERMIT ISSUED - ------------------ --------------DATE ----- ------ ------------- ---- - - - - -- ADDITIONAL COMMENTS --- Q - --------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------- ---------------- ----- - - ---------- ----------------------- --- -- -- -- --- - ---------------- --------------------------------------------------- --- ------ � -- ----=------- Final Inspection by - ----- n,.+o �l� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,