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FOR OFFICE USE: � _ y APPLICATION FOR SANITATION PERMIT - -- - ' ------- / ! �� Permit No: _&_� y (Complete in Triplicate) ----- -- , ----------I---------- ---i'A--------------- ,� _ This Permit Expires 1I 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 with.County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOV6?L__ N _ _r /7 6 _CENSUS TRACT ------..T- -------------- f Owner's Name --- ------------------------------------------------------ - -------- - Phone ----------- ••------- ------ Contract ,I Contractor's Name .License # X� Phone Installation will serve: Residence partment House,❑ Commercial ❑Trailer Court [] Motel ❑ Other ------------------------ •--------- J E� Number of living units:___/.___.__ Number of bedrooms '------.Garbage Grinder --/-------- Lot Size i (Nater Supply: Public System and name ---------------------------------•------------------------------------------------------------•--- -----Private Character of soil to a depth of 3-feet: Sand'❑ Silt❑ Zla{ ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material _ __ If yes, type ________ __________________ t (Plot plan, showing size of 14o't� location of system inrelationtjo wells, bu ldings, .etc. must be placed on reverse side.) N NEW INSTALLATION:o(No-septic-tank or•-seeps -pit-permitted-if-public-sewer is available within 200 feet,) ' PACKAGE TREATMENT { ] SEPTIC TANK j Size_7----_--___/___ __---.-.---_ ,___ Liquid Depth ____174__________________ # 1 Capacity a eGG Material,e�P/NC.!y __-t P No. Compartments P Y YP s , r v istance to nea t: Well ---------.7V-__-______________Foundation t`'",l�_____ -___ Prop. Line .- __�._-_____-_ LEACHING LINE [' No. of Lines ___ ___________ Length of each l;ne_____7_(�{ .___.__ Total Length .l-1'�'E?_- ___._-_ D Box ___ .E__.._ Type Filter Material __ 5, ____De th F�rlter Material - YP P % - , f Dis#ante o nearest: Well -----,��--- _____ f=oundation :lam______.____ Property Line. F" SEEPAGE PIT [ Depth ._�� .____.__ Diameter _33______ Number -----�--------------- Rock Filled Yes No .(3 Water Table Depthf Rock-Size -----�fi�---,d-`-„,�------- Distance to nearest: Well ---WgPt----_------------------Foundation Q__ .---- Prop. Line _s...____.____.___.. i tr REPAIR/AD DITION(Prev. Sanitation Permit#i______------f ________tI--------------- Date ----------------------------------1 - L� Se tic Tank (Specify Requirements) ---------- --�----- ----------`------�------------------ ---------------------- Disposal Field (Specify Requirements] ----------------------------------------------------------------•--------------- �� , ---. . a. --------------------------, _ ___________________ ___________ ________.__--------------__-__ _-____________________ r: ':___________________-____________._________________________________ - .. .._._. _-__.. - (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the!!warkswill be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the. San'Jociquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I tertify 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 Compensation laws of California.” 3 Signed - --- ---- Owner --- ------ Title $ BY ° = --------------------------------- (If other than owner) j DFf" TMENT USE ONLY APPLICATION ACCEPTED BY --- - - - ----------------------------------------------- DATE _ =Z BUILDING PERMIT ISSUED --------- - --- --- ---- - ----------- ------ --------- -------------------------------DATE --------------- ---- ------------------ A1__D TIONAI COMrNT��- 33-- a--'--�- - -- -- ------ ------------------------------------------------------ ------- -- -- --------------- - ---- ---------------------------------------------------------------------------- --------------- .--------- - t Final Inspection by: ------------- ---------------------------------- -------------------------------- .Date --- ��=/•� `�f�- ?��:� OAQUIN LOCAL HEALTH DISTRICT r `,t E. H. 9 . 1-'68 Rev. 5M.