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FOR OFFICE USE: I �� APPLICATION FOIL SANITATION PERMIT 4 Permit No: ---------- ---------- ------------ 7- (Complete in Triplicate) -- --------------- Date issued -------------------- ---------------------------------- ----------------------------------------------- - -------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein I described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .__�-2��----------:-� r------ ----------------------------------- ----CENSUS TRACT ----------- ------------- �C p 5 1 Sn .Q�- ---- ------------- I-------------------Phone Owner's Name - - °�----�---.-Q ��•--------------- --------------•------- ----- ` -sz- ------------------------------------------------- City --- oc_ - ---------------------------------------------•---- Address _- -`?------- 1 use Commercial C--._---- Phone Y -_?- -C� ?------• Contractor's Name I Court f Installation will serve: -Residence 5[] Apartment Ho ❑ Motel ❑Other --------------------------------------------a Grinder ------------ Lot Size ------------------- i r arba --l .--"---�� t Number of living units ----- Number of bedrooms ___� g I - / - Private ❑ Water Supply: Public System and,name - Character of soil to a depth of 3 feet: Sand T4 Si ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam El Hardpan ❑ Adobe Fill Material ------------ if yes, type ---------------------------- F . (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,) fCiSize Capacity -------- ------- Type -------------------------------- Liquid Depth ----------------- - ------ N. PACKAGE TREATMENT ( ] SEPTIC TANK ` --- Material---------------------- No. Compartments --------.------------- N -----.�-------- - �,D.'stae to nearest: Well .......------------------------------Foundation ---------------------- Prop. Line ---------------r------ of Lines ----------- Length of each line---------- ---------- ------ Total Length •----------------------•---- LEACHlN 15 'D' Box I----------- Type Filter Material --------------------Depth Filter Material ------------------------------ --------- Distance Property to nearest: Well __--------------------- Foundation ---------------- - P tY SEEPAGE PIT [ ] Depth£ -- Rock Filled Yes No � --------- ---- Diameter ,---�------------- Number ----- --- --------- -- ❑ .3! - S Water Table Depth ----------------------------------------------- dRock Size Distancto nearest: Well -_------_------------------ -Foundation -------------------- Prop. Line -..----_------- 1 Date ---------------•----•------•----) REPAIR./ADDITION(Prev. Sanitation Permit�# --------------------------------------------- t ------------------ Septic Tank {Specify Requirements) - - ----- ---------_----+ ------- ---------- ----------�-------�-------------- --•---------------------------- Disposal -- ------------- --------- Dis osal Field (Specify Reqrements)-_Ci ---QR � -------- � ---�--- E 4- ,.------;--- ----- =---- --- ------- �-= .,�-► � c, hLS- - ------------ ---`----- ---- - t i -------------------------------------------------- = = (brow existing and required addition on reverse s d e_ I hereby certify that 1 have prepared this application and that the v✓ork`•will be done in accordance with San Joaquin County Ordinances, State Laws; and Rules and Regulations of the.San Joaquin Loccal,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 Co pensation laws of California." Signed _ -...� --- --- --------------------------------- Owner ------------------------- = Title -------------------- -- ------------ - ------------------- (If other than owrier) ' 1I FOR DEPARTMENT USE ONLY 7 l — `� 2---- APPLICATION ACCEPTED BY -- = -- --- v!'--C��DATE -----•------ -- - -- BUILDING PERMIT ISSUED --------------------------------------------- -------- -----DATE -------- --------------------------------- - ADDITIONALCOMMENTS -------I----------------------------------------------------------------=----=------------------- -------- ----------------------- -------------------------------------------------- 1 - - ------------ -------------------------------------------- --------------------------------------------- --- - ----------- -------------- ----------� - ---- . x----- ---------- - ate --------- -------- --- Final Inspection by-- ------------------U`�___�` k --------------------------------------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M