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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a� ' e (Complete in Triplicate] mit No: --711=6(--- ---------------------------------------------------------- ___._-________________________________________________ This Permit Expires 1 Year From Date Issued Date Issued - --- __-.. i 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. 349 and existing Rules and Regulations: JOB ADDRESS/LOCATION :______ i _ __\_�j ___:__F-_______ , CENSUS TRACT __________________________ ------ JOB - ------------------------ Owner's Name �/� {� �?, lr,� ..----------------- ----- ----�------- - Phone��-g--- r�.`1 Address __673-6 4- A-404 Contractor's Name --- --`- �.- ---4J << .---------------------------------------------License # _ ,_ Phone Installation will serve.�_.Residence-&Apartment_Hpuse_❑_Commercial :❑Trailer Court',❑_ Motel ❑Other -------------------------------------------- Number -------------- -- - ---- -Number of living units:-._ ------- Number of bedrooms ______Garbage Grinder -------- Lot Size __ _�________________________________ - Water Supply: Public System and name --------------------------------- -- - - ---------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'[1 Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type :___________ ______________ (Plot plan, showing size of iot, 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,) /l PACKAGE TREATMENT ' [ ] SEPTIC TANK [ ] Size-.-_ _X'341._LO______________________ Liquid Depth __ ................ Capacity --.---_ Type 9 .Material______________________ No. Com artments ---�---------=---- t 1 0 Distance to nearest. Well ------ --- __Foundation ---------------------- Prop. Line ___---------:_,______ LEACHING LINE [ ] No. of Lines ______ g r g -------------- Length of line----��'�---------- - Total Length 'I'D' _1`�___�____...-•__-• N 'I'D' Box -- -_____ Type Filter Material 1«' __Depth Filter Material ____4 ' _------_....................... 00 'Distance to nearest: Well _:G� -----_---- ----- Foundation 41---------------- Property Line .------------------------ SEEPAGE ______________._____SEEPAGE PIT [ ] Depth _,;;)-tj_-________ Diameter . K� r__ Number ______ -------- ------ Rock Filled Yes g No i❑ rn Water Table Depfh ------------------------------------------------Rock Size -------------- -------------= 1- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ____-_________________ I REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________) t Septic Tank (Specify Requirements) --------------- = ------------------- - l Disposal Field [Specify Requirements} --- _.-------- j = ------------- N . - ----------------- --------------------------------- --------------------------------------- --------------------- ------------------------------------ ----------------------- ' ! f _ . , --------•------------------------------------ (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 perfork mance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to ork n's Compensation laws of California."------------ ) Signed-- -S Owner By ------------------------------=------- ------------_,;-------------------------------------- TifA ------- ----- - ----` J � (If other than owner) =--FOR-DEPARTMENT-USE -ONLY— APPLICATION ACCEPTED BY _- - -- - - ------ ---------------------------------------------------------- DATE ------------ -- BUILDING PERMIT ISSUED ------------------------------ __DATE --------------_------------ ADDITIONALCOMMENTS ----------------=---------------------`-------------------------------------------------------------------------------------------------------- --------------- -------------------------------------------------------------------------------------- ------ ------------------------------------ Final Inspection b Date ------------------------------- - ---- ----- ---=- --- ----- --- py: - ---- ------- —-- -------------------- -- - r SAN JOAQUIN LOCAL HEALTH DISTRICT W E. H. 9 1-'68 Rev. 5M i