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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- ------ - --- ----------•----- -��,� (Complete in Triplicate) Permit No. ---------=-------------------------------------------- -- -----------------------------------------_--------------- This Permit Expires 1 Year From Date Issued 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: �, y 9f- JOB ADDRESS/LOCATION -----------�^ -------- ----------- ----�----------=----------------------`�'-- -------- -------------CENSUS TRACT -------------------------- Owner's Name " I °�` Phone - ----- -- ------------------- Acid ress �t_ __ ' • y � r ------ ------------------------ Contractor's1� i-- -- �.-_-- -- ��r---/�1��.Li License� .��_�__. Phone ---- ..... ..... Name ._-�'- -- ---- ----------- � ,��-4�6�-5-_-- Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------------- Number of living units:___ _____- Number of bedrooms -a------Garbage Grinder,____ Lot Size __4' R_"_CT_iZ--_---_--_- Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'V Silt E] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe-❑ Fill Material -NO If yes, type --------- 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 [ I SEPTIC TANK.) I Size_____________________ ___ Liquid Depth ____________•_________ Capacity -------------------- Type ---- --------------- Material---------- ----------- No. Compartments ------------------•--- (� Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --------•-._.___--..-- �l LEACHING LINE [ J No. of Lines ------------ ------ Length of each line---------------------------- Total Length _.__________________________ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material __________________-__________________._._ Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line -------------------_.--- SEEPAGE PIT [ ) Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------"----------------------Foundation -------------------- Prop. Line ----------......-.REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ..........................-..__.._) Septic Tank (Specify Requirements) __________________________________________ Disposal 'el (SpecifycRequirements) -- ----- ----- 40..e------ --------- -- - - --`^ru- -�`'C �/ � •"�------------ ---------- ---------- ------------ -------------------- (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 bec subje Wor an s ompensat' laws of California." Signe I 7r-. �------- - ` � r ---- ------------- Owner Y -------------- --------------- ---------------- Title (If other an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------F3_,0------ -------------------------------------------- ---------------------- DATE ----- -- -- J-3 -------- BUILDING PERMIT ISSUED ------------------------------------------------------------------------------------------ --------------DATE _-. --------------------------------------- ADDITIONALCOMMENTS ------------------------------ -- ------------------------------------------------------------------------- ------------------------------------- ------ --------------------R ------ - -- - -------------------------------------------------------------- -------------------------------------- ------------------------------------- - -- --------- -- ----- ----- - -- - ------- ------- - ---------- Final Inspe Date p •-------------------------- - 1.3_- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT / E. H. 9 1-'68 Rev. 5M