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`< FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �4� --------------------------------------------------------- Permit No. _ (Complete in Triplicate) `�/ Date Issued _1_-/6 P _------___------- -----------I—--__-_---_---_--- This Permit Expires 1 Year From 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 compli ce with Count rdin nce No 349 and existing Rules and Regulations: 117-4 JOB ADDRESS/LOCATION .- -- --�1`__T_----_--d__-__-- -- -------- CENSUS TRACT -- --- ---_--�_-- --------- _ Owner's Name ------------------Phone �! � ,. Address - - - City ----------------------------------------------------- -------- --- _ -- Contractor's Name �-I _-�- ------.License l-��_�� Phone Installation will serve: Residence 0 Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------------- .,L �// Number of living units:----I------ Number of bedrooms _, __/____Garbage Grinder/�_l1___ Lot Size -73_ ___iC_l___ ------- Water Supply: Public System and name --cam:::--a/-----Ltd_ r------------------------------------------------ ----------------.Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam W Hardpan ❑ Adobe'k Fill Material __________ If yes,type _________________________-_ (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,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size-----------------------------------_____------- Liquid Depth __-________--_---__-_-_ r/Ley Capacity -------------------- Type ------------------- Material-------------------- No. Compartments --------- ---•--------W Distance to nearest: Well ______________-________________Foundation ---------------------- Prop. Line _________ LEACHING LINE f No. of Lines -----/---------------- Length 9f each line------ -------------- Total Length ,____-�0____--_---__ 'D' Box _f Type Filter Material ------------------_ __Dept ilter Material _41�1._ ___-_____-,- Distance to nearest: Well _______________________ Foundation Property Line ----------•___......... . SEEPAGE PIT Depth ------ Diameter _` Number ------ ,-` _________ Rock Filled Yes No ❑ Water Table Depth /I - / 37 -------------- ------------ Rock Size y SW Distance to nearest: Well ____,/_V_�J7)-s --------------------Foundation __�__ ___,_.___ Prop. Line _.._ ._..._...to REPAIR/ADDITION(Prev. Sanitation Permit# _____, ---------------- Date �0 Septic Tank (Specify Requirements) ------------------------------------------------------------ -------- .,. --------------- -1 Disposal Field (Specify Requirements) _____re �� ---------------t --------------------- --------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- (Draw ------ -_ ------------------------------------------------------------------------------------------- (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 subject to Workman's Compensation laws of California." Signed ------------------- --------------------- ------ Owner _. .... BY - �----------------------- Title ------� (If o hef 'r rlhan caner) FOR DEPARTMENT USE ONLY 7 APPLICATION ACCEPTED BY - ------------------ ------------- DATEI --Z ------------ BUILDING PERMIT ISSUED ----------------- ----- -------------- ------ --------- DATE --�------------------------------------ ADDITIONALCOMMENTS ------------------------- --------------------------------•---- ---------------- ----•------ ----------------------------------------------------- ----------- ------------ ---------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- --------- --------- ------------------------------------------ -------------------------•--------------------------------------------------------------- ----- ---- ------- ----------- - - - - --- -- --- --- ---- -- -------------------- *� -- Final Inspection by: - ---------------------------------Date -- JlJ SAN AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M