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F FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT Permit No: --------- ---- ---=------------------------------ (Complete in Triplicate) � --------- C I ---�_ This Permit Expires 1 Year From Date Issued bate Issued -�.!!--_. C7 r ------ - e --------------- i 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: JOB ADDRESS/LOCATION ogS0G/_------- � G -------------------------------CENSUS TRACT --------------- -- - ---- s Owner's Name ----- J. Z--- --- "AJ -- r -----------=-------------- - -7-----------Phone ------------------------------------- -------------- ---- ------------------ --- ------------- ---- -- - - ------- City ---------- Address s Contractor's Name ! unse # /2Z3,*'P- Phone --------------•--------------- r � Lice Installation will serve: ReSid encApartment House'[] Commercial ❑Trailer Court I❑ IMotel ❑Other ------------------------------•------------- -� Number of living units:----f------ Number of bedrooms __y____Garbage Grinder ------------ Lot Size __-D-Cr _ec ------------- Water - -----Water Supply: Public5ystem and name ---------------------- ------------------------------------------------------------------------------------__Private Ell' a Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ .Peat ❑ Sandy Loam -❑ Clay Loam.fFl— a Hardpan ❑ Adobe '❑ Fill Material ------------ If yes, type ---------------------------- (PI'ot 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 [ I SEPTICTANK;j ] Size----------------------------=-------------.------ Liquid Depth --------------------------- L --------------- ,-----L Capacity - -;---- Type ------------------- Material---------------------- No. Compartments =----------------=-- Q ., Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line .-.----------:--------- \. LEACHING LINE'~ [ ];. No. of Lines --------`-------------y'Length of each line---------------------------- Total Length ------------ ------------ 'D' Box ----------._ Type Filter Ma#erial ____ _______________Depth Filter Material -_-___________-____.----------.---------- _ VM f Distance to nearest: Well -- --:--_____-- __ Foundation ------------------------ Property Line _______....._____.___... ii SEEPAGE PIT [ ] Depth --------------------- Diameter ____________{_ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ----------_r- --Rock Size -------------------------------- Distance to nearest: Well -------------------------------------w-Foundation ____________________ Prop. Line .._._______•_--___-__. i REPAIR/ADDITION(Prev. Sanitation Permit# ____.__.__�_- _-------------------- Date _________________..____ i Septic Tank (Specify Requirements) ---__=- - ' y t y r - r osal Field' [Specify Requirements) __ ' ,y--rc .�--- --- ----�.�---- r �------- ------------------------- ------ r-- r __-_-. {Draw 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 subjectfto Workman's Compensation laws of California." Signed ---------- Owner - BYTitle ------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- ------- ------------------------------------------------------------- DATE /0--`-- ---- 7 -------------- BUILDINGPERMIT ISSUED ------------------------------ ---------------------------------------- ------------------ --------------DATE -------------•---- ------------------------ ADDITIONAL COMMENTS ------------------ ----------------------------------------------------------------------- ----------------------------------------------------- --- ---- -------------------------------- ------------------------------------------------------- i ------------------------------------------ ------- --------------------- ---------------------------------------------------------------------------------------------------------- -- - - --- -------------- ------------------ - -- - ----- -- --- --- - Final Inspection by: ------------- -------------------- -------------- - -------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT r, E. H. Y 1-'68 Rev. 5M '�