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FOR OFFICE USE: _ eAPPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit _______________ --- _ -------------- This Kermit Expires 1 Year From Date Issued Date Issued� _ ��_?� j S eP Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein j described. This application is made in compliance with County OrdinanceeNo: 549 and existing Rules and Regulations: 3 JOB`ADDRESS/LOC N .-- b-7 7 -- -------- F ""�'`J- -- - - ---------------CENSUS TRACT --------------------..,... Owner's Name'- -------Phone ------------------------- i-------------------------------------- Address ------ -- Address ----------------• `J� --- 11A `J - ----------- City -. - --- - - ---` -------------------------------------- Contractor's Name -- ----= ; ___________License # _�� -3 Phone __________ - Installation will serve: Residence Apartment House❑ Commercial :MTrailer Court i❑ »_.__..._,_,Motel-.Other __----=------------------------------------ Number of living units:---_ Number of bedrooms ______Garbage Grinder ------------ Lot Size _______ Water Supply: Public System and name ------------- ------------------------------------- ----------------------------=-- -- ---------------Private Character of soil to a depth of 3 feet: Sand'E] Silt❑ ^Cl_ Q- Peat❑ ~ Sandy Loom ❑ Clay Loam Hardpan ❑ Adobe Fill Material ----- ------ If yes, type ---------------------------- " (Plot plan, showing size of lot, location of system in relation to wells buildings,. Y g , 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'r< Size_Sl_ 1--- '_� '-��___-_ f1 i - ------ Liquid Depth T--- ---------------- capacity _ O_rS--L _ ype /fie- Material__--_- a. Compartments �... __ d� l / { Distance to near t: Well ------5------------------------Foundation ___ _G � 't /- - - -------- Prop. Line ------------- . LEACHING LINr_""No. of Lines ----- =:7 Length of each line------ !__=___j' _�Total Length i 'D' Box - Type Filter Material --- ----- Filter Materia! --�4---.�--_---•------•�---......... E .. Distance to nearest: Well -_ __'___________ Foundation ------/_6__---------- Property Line _ ....------- .:.... SEEPAGE PIT [ Depth ---AS---------- Diameter ----------------- Number ---------------------------- Rock Filled Yes o .❑ i Water Table Depth ------------------------------------------------Rock Size ------� rTt Distance to nearest: Well -----------J-*—_C0__----------------- Foundation _______l_G__� Prop. Line -------S_-_--_-_--- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------_------------_) Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------- --------- ------ Disposal Field '(Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- i ---------------------------------------------------------- f I (Draw existing and required addition on reverse side) f 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 f 'n the performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco a bject to Workman's Compensation laws of California." Signed ---- ---- ------- -------- ----- ------- --- Owner ------- ----------------------------------- � BY - - a��---------------------- Title ------ (If other than owner) s i FOR DEPARTMENT USE ONLY T APPLICATION ACCEPTED BY . ^------'----- ''�------------------------------------------------- DATE / -- -' BUILDINGPERMIT ISSUED ------------------------------------------- ---•-•-------------------------------------------------------DATE ------------- ------------------------•---- ADDITIONALCOMMENTS --------------- --- - ---------------------- ----•---------------------------------------------------------------------------------- -------------------------------------------------------- - --- A - - ------------------------------------ ---------- ------------------------------------------------------- ----- - -- --- - -------------------------------- -----------------------*--------- -------------------------------------- - - - - ------------ ------------------------ ---------------- -- --------------------- --- ----- --- Fina! Inspection by ;. ----------------------------------------------- - -------.Date _r .3` --- --- SAN JOAQUIN LOCAL HEALTH DISTRICT ,. E. H. 9 1-'68 Rev. 5M.