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FOR.OFFICE USE: APPLICATION .FOR _SANITATION PERMIT - /r�1 �sb .�- Complete in Triplicate) Permit No. -------------------- Date _�� _______.__.. 1 ` Date Issued ________-__-___--_-______- ------------------- �' ` 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._ _r�T— �_ �•`-' 7fv+*- -----CENSUS TRACT Owner's Name u I1 - - _ Phone -------—-----�__--------l__ Address ,a/��'� dK/_ ----------------------------- City ------------------------------------------- Contractor's '�j�„ ,meq Contractor's Name _ ®� Cf,/` --------------------------------------------------License 90 / Phone Installation will serve: Residence [g Apartment House❑ Commercial ❑Trailer Court I❑ Motel ❑Other -------------- =---------------------------- Number of living units:-- --- Number of bedrooms __ -..Garbage Grinder ------------ Lot Size -------------------------------_____________ Water Supply: Public System and name --------------------- ---------------------------------------------------- --------------------------------Private (K Character of soil to a depth of 3 feet: Sand K Silt fl Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ 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,[ ] S_ize_---S�c _W t c3/S_XAuid Depth .c�_______-'------- Capacity ------ Type -_ _ �u'Q-f Material__Q_Wow No. Compartments ..3............... J Distance to nearest: Well _________________ _Foundation ___�.O_-__-_--___ Prop. Line --- _-___---.._ 00LEACHING LINE [ J No. of Lines - -___--__-_ Length of each line--/d----------------------------- Total Length ................ 'D' Box ----J---- Type Filter Material ----Depth Filter Material �`�-------------- ------------------ Distance to nearest: Well ...... -------- Foundation ___ ��_____r________ Property Line .47.__...... SEEPAGE a_..__......SEEPAGE PIT [ ] Depth ---------------- --- Diameter ---------------- Number -___-- -------------------- Rock Filled Yes 'Q No iQ . Water Table Depth ------------------------------------------------Rock Size -------------------------------- V Distance to nearest: Well _-______-- ______- ,__---- ----Foundation ___________________ Prop. Line ...................... 'I REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________) 0 SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ------------------------------------------------------_-- �. Disposal Field (Specify Requirements) ____________ _______________________________________•__ 1 ---------------------------------------------- ------------------------------------------------------ --------------------------- I------------------------------------------------------------------ ---------- ---- ---------------- -------------------------------------------- ----- - -- --- ------------------------------------------------------------- (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 other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- - ---------------------------------------------. DATE ---4_2:7"?2;� ��` -------- BUILDINGPERMIT ISSUED -------------------------------------------------------------------------------------------------------DATE ------------------------------------------. ADDITIONALCOMMENTS --------------------------------------------------------- ---------------- ----------- ---------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- ------ --- ------------------------------------------- ---------- !v 2 w -------------------------------- -- - -- - ------ ------ ---- ----- -- p Y: ------------ ------------- -- --- ----------------------------------------------------------------------Date ----------------- Final Inspection b -----��-- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M