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FOR OFFICE USE: 12q- i-7°- r3 APPLICATION FOR SANITATION PERMIT ��- ------ ---- ------------`��-'-��-� Permit No. - �----------------- (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 R uI tions: ter- /� � s �' JOB ADDRESS/LOCATION= __,�'_ J &J _f_S_` `4�t c v__�� _�1/__ ' CENSUS TRACT ________ ______________. Owner's Name __Z-0 --------- -------Phone ------------------------------------ - ---------,-----.-•--------- Addres)1411 -�l`--- ----------- City �/(i`' --------------------------••-----•---•-- Contractor's Name ___ r_►�;/--._______________________-._-__._____.License Phone Installation will serve: Residence 10 Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------------ Number of living units:----/---- Number of bedrooms t3------Garbage Grinder/.j-__ Lot Size 0F41-dr_ __ _-�---------- Water Supply: Public System and name ------------------------------• -------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat; Sandy Loam X Clay Loam EJ Hardpan E] 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__ -02X-6 --------- ------------ Liquid Depth ,$1___-_-_-__--_- Capacity/.2,47P____ Type -- Material4erwe_c_____ No. Compartments ____ — _ __ Distance to nearest: Wel ____ _ ______ _ __ __ Foundation _ _ _ ___ Prop. Line . i LEACHING LINE No. of Lines NY---------------- Length of each line__eep--------------- Total Length ------------ 'D' Box)/Of✓._ Type Filter Material , Depth Filter Material ��__�--_ Distance to nearest: Well _t�J!'__`________ Foundation ----------- Property Line _607Z?.j..--.-- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ___________________________ Rock Filled Yes ❑ No 0 WaterTable Depth -----------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ___________________________-_________--Foundation ______ ------------ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------- ________________________________ Date ----------------------------------) SepticTank (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 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 Com ation laws of California." Signed ------------------------- - --- ---------------------------------- Owner BY - ------ --------------------------- Title ----- they than owner) FOR DEPARTMENT EON APPLICATION ACCEPTED BY----------------------------------------- - ------ -- ---. DATE ---- - --•--------- BUILDING PERMIT ISSUED ------------------------- --DATE --------- ------------------------------- - --- --- ADDITIONAL COMMENTS - - - - - -------------------------------------------------------------------------------------- ------------A ------ - ------------- ------------------ -------•-------------- ------------------------- -------------- Final Inspection by: ----------------- Date --------------------------------------------------------- - - l -------- SAN JOAQUIN OCAL EALTH DISTRICT E. H. 9 1-'88 Rev. 5M