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FOR OFFICE USE: --------------------------------------------- APPLICATION FOR SANITATION PERMIT v s (complete in Triplicate) Permit No. -- ------------------ ----------I---------------------------------------------- ------------------------------------ This Permit Expires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 ._ _�f��2�_ ___ ________ _ ._____CENSUS TRACT - A ______ Owner's NameA`=^' ' �a-- Pr - Phone ---------------------------- Address -------- �CaT�2, � ./��t?C <� ----------------------- Cit / Contractor's Name ----- ---e— ---------------------------- License # ------------------------ Phone -------------------•---------- Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court '❑ Motel ❑Other -----------;-------------------------------- Number of living units:-_-�--,/--_ Number-of-bedrooms _:___:Garbage ____--__---- .--.-_--- Grinder Lot Size - ��-�_______________ Water Supply: Public System and name ------------------ -•- -- --------------------------------------------•------------------------------------Private Character of soil to adepth of 3 feet: Sand Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material -------------ffyes,-type----__:_____________________ (Plot plan, showing -size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ` lit NEW INSTALLATION: (No septic tank or seepa it permitted if public-sewer is available within 200 feet,) V PACKAGE TREATMENT' .[.,] SEPTIC TANK T Size_-___,_______:____________ ------------ Liquid Depth .___- - -------------- � //��_ _ v. Capacity J2.�_____.__ Type(91 /_____ MoterialC�*_-e_____ _ Compartments` � No. Com ------�9-------••--- stance to nearest: Well -----/k5-- --------------------Foundation _/0-------------- Prop. Line ----ZjC&----______ N LEACHING LINE No. of Lines _.___.�------------ Length,of each line-----X0.r____.__._-_ Total Length - 'D'•Box�.Ps___hype Filter Material �?A Depth Filter Material _..._1 ______ ________________________ Distahce fb nearest: Well __.r`�___________ Foundation ---&-2 -- Property Line ____________________ e Depth�f !?Px __ Diameter�, ______ Number __...2------------------- Rock'Filled YesO No i❑ Water Table Depth --------------------------'-----------------------Rock Size ------------------ ------------- Distance to nearest: Well -----------------------------------------Foundation ------------ ------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ____ __ ________________l_________ Date __ __ } Septic Tank (Specify Requirements) -------- "¢`y �', -------------------------------------------•--------------------------- Disposal Field (Specify Requirements) ________________ -- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 su2er 41* 6'rkma Comnsatior la sof Ca€ifornia."Signed .�__._ Owner L BY ---------------------- -----------------------------------------------------------------------• Title ----------------------------------------- ------------------------------ (If than owner) TR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- __ - -----. DATE ----6-=�- - ----------- ------------------------------------------------------------------------ BUILDING PERMIT ISSUED -------------- - ---- ------------------------------------- ------------- ---------------=--------------DATE ------------------------------------------- - ADDITIONALCOMMENTS -------------------------------- --- - -- - - ------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- ---- -------------------------- ------- - Final Inspection by: -------------- -- - - Date _._�-�_?-- Z... _. _>------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 T-'68 Rev. 5M