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J FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT F --- ---------------- ---------------- 1_ Permit No: ._ -_3F 3 j ---------------- (Complete in Triplicate) �__L--- __ 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 wit ounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/90CATIN . '7-------�----------------------- --------- - ---- --------------CENSUS TRACT _S �C--------------- Owner's Name ---` -------- -- -----------------------` ----------------------- - -------Phone --------------------------- Address 6 �? ----- ," C.-_. City - - L; / p Contractor's Name -__-- ---- ----- ------ - -_�_-------_ _�__ _� -_ --.License #/�G.3 _ Phone ------------------------------ installation will serve: Residence �partment House❑.Commercial ❑Trailer Court Motel ❑Other ----------------- -------------------------- Number of living units:......I�_____ Number of bedrooms ___Garbage Grinder -- -------- 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.m Hardpan (� Adobe '❑ Fill Material ___________ If yes,type --------------= ------ i (Plot pian, showing size of lot, location,of system in relation to wells, buildings, etc. must be placed on reverse side.) 0' NEW INSTALLATION: (No septic tank ci "seepage pit permitted if public sewer is available within 200 feet,) Li PACKAGE TREATMENT [ ] SEPTIC TAMC f ] Size------------------------------------------------ Liquid Depth ____._______________.._ Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ---------------.-° . Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --------.._..__....... LEACHING LINE [ ] No. of Lines --- ------------------__.,length of each line_______________ __ Total Length -----------................. 'D' Box ------------ Type Filter Material ____________________Depth Fitter Material ----------------------------------- -------- Distance to nearest: Well __ ___--------------- Foundation ------------------------ Property Line __-____________.__._____ SEEPAGE PIT [ ] Depth ___________________ Diameter _- ___________ Number ---------------------------- Rock Filled Yes ❑ No C3 r Water Table-,Depth ------------------------------------------------Rock Size ____________________ ) Distance-to-nearest:,Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- r REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 Septic Tank (Specify Requirements) a' --------- Disposal Field (Specify .Requirements) `--G-____2 - �_ - - �r a r ------------�-------------- `- -----------------------------------------•------------------------ ----------------------------------------------_=------------------------ ------=--------------------------------------------------------------------------------------------------------------------------- raw 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 Workman's mlpensati.on laws of California." p Signed ---------------------------------------- --------3------•- Owner ._z: ---- BY - -----------: ten-' title i I ----- -------------- - ----------------------------- (If other than owner) s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE _r ~�~` BUILDING PERMIT ISSUED ---------- -------------- -____.._____DATE ADDITIONALCOMMENTS -----------------------------------------------------------•---••-•------- ---------------- ----------------- ------------- ------------- -•----------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- --------- ------------------------- -- -- ------------------------------------------------------------------------- ------------------------------------------- ------------------- ----------- ------------------------------------------------- --------------- - Final Inspection by: ? Date _s -------- -----`�--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M y