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FOR OFFICE U-SE- ---------------: APPLICATION FOR SANITATION PERMIT ' ---- ----------- ---------- -- - -- -- �� Permit No.. _7�"a'-7� (Complete in Triplicate) --- ---------=------------I------------------ --------------- Date Issued .__..�lS'.7 -_-------------- --- --------------------------------- This Permit Expires ] Year From Date Issued t 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: 4 JOB ADDRESS/LOCATION ._ _b _L'_-- --1�� 1 ___ _ _ ____1-7,-YG�Ak!_2r_�.V .P ENSUS TRACT ----- -------__ Owner',s Name -fes N �J�� _fk! i � - ' i9��Ph one z Address City 1l_Y0/'Gl� Contractor's Name ---- � � �Ice---- - ------------------------License Phone6'::23-Z-'- --u- c-�' -_. Installation will serve: Residence Q[Apartment House❑ Commercialrailer Court,! j Motel ❑Other ---- -----------------------------•--------- Number of living units:-_-(_0_-_ Number of bedrooms -------- yGarbcge Gr]nder ------------ Lot Size _.________________________________________ Water Supply: Public System and name ----------------------------------------------------- i------ ---•-------------------------- ------Private-El \ —Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay ❑ Peaf❑ Sandy Loam] Clay Loam El (f Hardpan ❑ Adobe-F] Fill Material------------- If yes, type --------------------:------- r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 9' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT {-] SEPTIC TANK'[ ] Size--------------------------------------------------'- Liquid'Depth ---_.__.____-_._.-- - -------- f ry I Capacity =- - ------------ Type ------------ ------ tenial---------------- ---- No. Compartments ------•--------------- Distance to nearest: Well ----------------------- -------------Founda 'on --------------:-------.Prop. Line -------------:_.-..--- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line--------- ________._______-__Total Length ------------.____-__-_-----_ 'D' Box _ ----- Type ype Filter Materia ___De h Filter Material _____________ _ c ��. Distance to nearest: Well --------------- -------- Foundati ------------------------ Property Line. --------------- r SEEPAGE PIT [ ] Depth 1-___-------------- Diameter __------------- Numb r ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth -------------------_" -- _-- Rock Size ----------------- -- - - -=----, ------------------ - - - - - ' Distance to nearest: Well _______ ______________ I=nundation Prop: Line ----- -•-------------- REPAIR/ADDITION(Prev. Sanitation Permit# ----------- ----------------------- ------- Date ------_-------------I--------------- Septic Tank (Specify Requirements) ------------------- --------=----------------------------------------------------- -------------------------- ------------ -------------- Disposal Field (Specify Requirements) _________ ------------ -- _. , `---------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) r - I hereby certify. that.) 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 Compensation laws of California." Signed y A ----------------------------- Owner By ------- - ---- - - - -h- C:C --------------------------- Title -------------------------------------------------- -- " � t (If other than owner) FOR DEPARTMENT USE ONLY E APPLICATION ACCEPTED 8Y -----1 - _dK--)------------------------------------------------------------------------------. DATE - --------- BUILDING PERMIT ISSUED -- --------------------------------------------------------------- - -------------------------------DATE ---------------------- ADDITIONAL COMMENTS ------- -- ----�= ---------------------- ------------------------------------=--------------------------- -------------- ---------------=-------------------- ----------- -------------------------- ------- ---- - - -- Final Final inspection ----------------------------------------------.Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M