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FOIL OFFICE USE: APPLICATION FOR SANITATION PERMIT a� � ---------------------- --------------------------------- Permit No. �.._...._. (Complete in Triplicate) -------------------- -----------.---------------------I____ This Permit Expires 1 Year From Date issued Date Issued -------------------- Application is hereby made1.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: I JOB ADDRESS/LOCATION _I�— -o_%/--- -=----- ---------- c - -----.........CENSUS TRACT --- -y- ------- e. a Owner's Name il --- ---------•-- ---------------------------------------•------------- --------------- Phone Address s2 ✓r/ - CityQ ' 7 P .. Contractor's Name -------- -- ---- ----------------2— - _ ---.License #1 3�Y Phone Installation will serve: , Residenc �Apartment House'❑ Commercial :❑Trailer Court ',❑ Motel ❑ Other -----------//---------••--------------------- x Number of living units:.-----I�-.__ Number of bedrooms -------y__-Garbage Grinder ------------ Lot Size ........... Water Supply: Public System and name _ -------------------------•-----------------------------------------------------------•-----------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.0 ,. Hardpan i ] Adobe '❑ Fill Material ------------ If yes, type ____________________________ i I (Plot plan, showing size of Ilot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: [Noseptic tank or seepage pit permitted if public sewer is available within 200 feet,} IN PACKAGE TREATMENT SEPTIC TANK [ ] '[ -------------- --------------------------------- Liquid Depth -------------------- ----- G' i Size = - Capacity ------------------ Type - ---------------- Materitil - =-' No. Compartments ---------------------- Distance to nearest: Well _ _ ____________-------! __ _____Foundation ---------------------- Prop. Line ---------------------- 11l LEACHING LINE Noll of Lines -----._ .-_ _ [ 1 - - ----------- Length of each line--------------------- ------ Total Length ----------------------.._... 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------------------------- "'nedri_ "Foundation Property Line ________________ Distance=;to nearest: WeII _..:____:__ ..____________________ SEEPAGE PIT Dep [ 1 ------------------ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No,IthC]^ ; . Water Table Depth ------------------------------------------------Rock Size -------------------------------- k Distance to nearest: Well ----------------------------------------Foundation __.----------------- Prop. Line -------------- ....... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------..------------------) Septic'Tank (Specify RequiIrem ents) posalField (Specify Requirements) __------------ -- t �-_-----_ V ---r . 3, ,IIF - � � y - ----------- �' X `S' ------ ------------ --- -- m- ---------------------------------------------------- (Dr ----------------------------------------------- ---- [Dr w 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 s6biett to Workman's Compensation laws of California." Signed ----------- ------------ ----------- Owner s k h it a Z�$YTitle ---- --- - I -------------- -------- w ---- (If othe II FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY,-- --------------------------------- ------ ----------------- DATE --- � - --------------- BUILDINGPERMIT ISSUED --1 ------ ---------------------------------------------------------•-------------------------------------DATE ------- ----- ----------------------------- ADDITIONAL COMMENTS ___'47 �� ------------------------------------------------------------------------------------------------------------------------------------------------------- :i ------------------------------------------ -- ' - --------------- ---- -------------------------------------------------------------------- ------------ FinalInspection by: ------- --------------- --------------------------------------•---------------------------------------.Date - ------------------------------- SAN ------ ------------------SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M