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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT c, �/ -------------- ------ ----------------------------------- Permit No. 1 / .—. �. (Complete in Triplicate) --------------- y rThis Permit Expires 1 Year from Date Issued Date issued _- _�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: fJOB ADDRESS/LOCATION -------- UGK,�AI __ G� CENSUS TRACT -------------------------- Owner's Name ......t(1-` ---------/ - - f -------------------• - -Phone ------------------------------ ' Address CU L' - -----------•--. Citi" s ------------------------- Y = Contractor's Name License # :5 __.Phone 4U /-Yfv'- Installation a!il,l-serue:-- _...Residence .Apartment-House=0 Corrmrnercial,i❑Ttailer Court i❑ Motel ❑Other-------------•------------------------------- ; f Number of liiving units:_-_ ___---_ Number of bedrooms= __ Garbage Grinder _______.__1 Lot Size,------ _____________________ f Water Supply: Public System and name ---------------------- --•-----•------------------------------- - ] -- •--- ------------Private] I Character ofisoil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 4 HardpanN Adobe '❑ Fill Material ------------ If yes, type ____________________________ ' I ! v 1 (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,) �� c PACKAGE TREATMENT SEPTIC TANK Size-_ Y�x y ] Li a Capacity -/P�----- TYPe `'9j� Material------------------- No. Compartments ---- r i - _A 1 Distance to nearest: Well _ �_�_________________________Foundation._________ Prop. Line _�P `___:_______. W LEACHING LINE [ ) No. of Lines ____I------------------ Length of each line......0�----------!------ Total Length ---------------- I � � I ss f0'd' Box ../------- Type Filter Material A?Xe,;Z-.Depth Filter Material ____ _________________ i Distance to nearest: Well --J��.I ..... Fou anon - �.�_--�_----_--- ProperI Line _1----------------- n SEEPAGE PIY [ ] Depth _f4"____________ Diameter Y1�f nor Number _.._ _______ Rock Filled Yes No C, Water Table'Depth ------------- --------------- �)---Rock Size ------ ------------------------- Distance to nearest: Well --------------------------------- - ----Foundation -- ----------------- Prop. Line ------------------ { REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- Date ----------- { ISeptic Ta Ak (Specify Requirements) ----------------------------- ------------------ --------------------------- •----------------- ---------•------------------------------ rt� I Disposal Field (Specify Requirements) -------------------------- ) ---------------- { --------------------------------------- I ------------- ------------------------------------------------- ------------------------------------ ------------------- ------------------------------------- �3``r' ' ' I----------------------------------- -------- ------- --------------------------------- ---- -- - '[ r'aw existing-and-regvirdd addition on reverse side); I I hereby certify that I have prep ed this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and ltegufations o;f the San Joaquin Local Health District. Home owner or liven- 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 sub)e to orkman's Compensation laws of Ca`lifornia." I Signed � �ti -------- Owner ; - ------- ! By - ----------------------------------------------------- --- ---=------- ---�_.-- ------ -- Title .. f....-....--...�.. �,.,.,�..�(If�,other than .1...,.�.1,--,,.,_,._...-�, Y.--�,,,.,,.,�.,4___,��_. FOR,DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY -------------._- �� DATE ------^ ^� ------------- BUILDING PERMIt'fl SUED_ kC--'.'-'N-------------`---=------ �` `� `'---- `---------------=--------------DATE ADDITIONAJL..COMMENTS --------------------------------------------- ` -4----�-fy - ------------ ------------------------------------------------------ ----------------- _ :�V }= ---------------------------------- -------------------- --- ,. ----------------------------------------------- - --- -----------------:---------------------------------------------------------- -------------- Final Inspection by -------------- Date -------�-�---�- -------- - SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M