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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ Permit No. (Complete in Triplicate) --------------------------------------------------------- ---_ This Permit Expires 1 Year From Date Issued Date Issued - 4--�—� 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 !/Ilf '------ _CENSUS TRACT ------------------•------- Owner's Named - x ------------ -------Phone ------------------------------------ Address .--------/ - -----3-id------- ------------�------ City �--�,/------------------------------------------------------------ Contractor's Name --��ts s r -- - /_�--------------------------------------------------License # _A7.X5I0� Phone ------------------------------ Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court Motel ❑ Other -------------------------------------------- Number of living units__------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size t -------_-.-_--________ Water Supply: Public System and name ------------------------------------------------------------- -------------------------- -------------- Private Character of soil to a depth of 3 feet: Sand'[+ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam im Hardpan ❑ Adobe-E] Fill Material ------------ If yes,type ---------------------------- (PI'ot 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 PC] ----------------- Liquid Depth -_S�-----------.-,----- Capacity ----- Type- - Material_. _- No. Compartments -3 __-------------- � 77 Distance to nearest: Well ---- -------------------------Foundation -j_-O--------- ----- Prop. Line 4�----- ------------ LEACHING LINE [ ] 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 i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------_) SepticTank (Specify Requirements) -----------------------------------------------------------------------------------------------------------------•<---------------------------- Disposal Field [Specify Requirements _- __-__ Af r � -p- ----- -----------------------------------//----- -- -------- - ----- ---- ------ --- - -=------- - - - -107----------------- ----------------------------------------------------------------- (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 certlfie a 0_11 wing: "I certify that in the pe r ante of the work-for which this permit is issued, 1 shall not employ any person in such manner as to become subiec o Wor arr s Compensation laws of California." Signed-v-� ---- -- -------- --- -- ------ ,- Owner By = ----------------------- ----- ----- -- ----- Title !.' --------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -1,1200441,- t - - --------- ---------- DATE " --------------- - ------------ - BUILDING PERMIT ISSUED -------- -----------------------------------------------------------------------------------------------DATE ------- ----------------------------------- ADDITIONALCOMMENTS ------------------ - ------ ------------------------------------------------- --------------------------- ,, ----------------------- - &' - - -- --- - --- Final Inspection bY= /�'.�G�'._ Date (t-------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M