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" FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT { - --------------- -------------------- Permit No. ----------------- (Complete in Triplicate} _ -------/p-----'4---------------- --- This Permit Expires 1 Year From Date Issued .gate 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. } , CENSUS TRACT ----------- -------------- JOB AQQRESS/LOCATI N 1-k_2-e-1------ r----- -------- ! ��--'---------------------------------------- Owner's Name --=--- - ----Phone ------------------------------------ - -- ---- Address --------- �4'We�Apartment -� �`------- City - Y c �Contractor's Name --- -----.License # ft��.- 8------..- Phone --- ------ ------------------------ € Installation will serve: ResHouse❑ Commercial ❑Trailer Court �❑ Motel ❑Other ------ ------------------------------------- Number of living units:.--.-- ----- Number of bedrooms ---3-----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 Loom Clay Loam ❑ \ Hardpan ❑ Adobe'❑ Fill Material -------------If yes, type _.------__.----------------- (Plot 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'f ] Size------------------------------------------------ Liquid Depth PY ---- -------------------------- Capacity T - -------- e -------------- ----- Material---------- --------- No. Compartments ------------------- -- - Type - ` Distance to nearest: Well ------------------------------------Foundation -.------------------- Prop. Line --------------------- LEACHING LINE [ ] No. of Lines ------------------------ rLength"of"each line"-------------------------- Total Length ----------------------------- i -----.---- ------i t 'D' Box ------------ Type Filter Material -------------------Depth Filter Material ------_------------------------•----------- Distance to nearest: Well ----- ------------------ Foundation ------------------- , Property Line --------------------- ] } SEEPAGE PIT [ ] Depth --------- ---------- Diameter -_------------- Number------ _-----wRock Filled Yes '❑ No It WaterTable Depth ---------------I---------------------------------Rock Size --------------- -------------- Distance to nearest: Well ------I---------------------- --...Foundation ----------- ------ Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ------ .-----f----------------------------- pate ----------------------------------1 Septic Tank (Specify Requirements) ----------------- -- Disposal Field (Specify Requirements) 0 41 `~`,''rj - {°`� I `j 4 ------------------------- ----- --------ti--'- - --- ---' -------------------------------------------- -----------' --.--------' 7.r _ _ _ _ --------------------------- --------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this,application and that the 'work w l_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 subject to Workman's Compensation laws of California." Signed ----- ----- � �j Owner -a�_ 8 - Title _ ----------------------- --- BY ---------- -------------- - --- (if other-than-owner) �_ FOR DEPARTMENT USE ONLY c.c@� DATE -.f_ ----------7---1-------------------------------- APPLICATION ACCEPTED BY --------- ----- � ------ BUILDING PERMIT ISSUED ------- ---------- ----- ------ DATE ADDITIONAL COMMENTS ----------------------------- -- -------- -------------------- -------------------------- -------------- -- ------------- -- ------ ---------------------------- - - ----- ------ ------- ----------------------- ------------------- .-DateFinal Inspection by ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.