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6 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---- ----------- --------- - --------------- ` Permit No: k ---------------- (Complete in Triplicate), ----------•--------------------------- 1 Date Issued __ 7_1.7_1 ------_ This Permit Expires i Year From 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: JOB 'ADDRESS/LOCATION, re --- ----�---�--- ----^--- --------------T--------------- -- ------CENSUS TRACT __________________________ /_ D 's Nam - ------ --- = Pho-------------ne ------------------------------------ Owner Address ��' � --- ------- - ------�� - -- ----- City r J ---- License.# _ `o Phone --------------_-------------- M.. Contractor's Name ----� - ---- �---- d Installation will serve: Residence ❑ Apartment House Commercial :[]Trailer Court '-.Cl ff Motel ❑ Other . - _ _ --jL -- h " Number of living units: _'_I-__ _ Number of bedrooms ___Garbage Grinder .-- ------ Lot Size ____4 � Water Supply: Public System and name -------------------------- -- --------------------------•- ---------------------------------------------- Privatex Character of soil to a depth of 3 feet: Sand'❑ Silt C1 Clay P� Peat❑ Sandy Loam ❑ 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.) bill NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK' Size_ __ ��, f Liquid Depth ______ _____________.-.___ 'f ------ T` Material___'�J'��-__•_ No. Compartments .. ..-- Capacity� {?�- yp - ---i--- --------- �. P ; Distance to ne rest: Well ---- ---- - --------------Foundation ---L_j9------------ Prop. Line -------------_--•--•-- LEACHING LINE [Pfl No. of Lines _-- /------------- Length -of each line-----/-4_p---__.___--_ Total Length 1-Da_..�---------- . 'D' Box f_._ Type Filter Material _r= v_____Depth Filter Material -----N--------------- ------------------ Distance to nearest: Well _____�5_-50------------- Foundation -----/_D..t_________- Property Line ----�__----------------- r i ' -Z�X_ ___ Number _.___--/________ _________ Rock Filled Yes � No �] Depth -��----------� -- - - - - r �b t ` Water Table Depth ------•-- -•_...---Rock Size --1-�_____X__�--•---- � ------------------------- - - - .. Foundation -----1-b-.-----. Prop. Line --`-�-------------- Distance to nearest: Well __________`_�©---___."� .. ` REPAIR/ADDITION(Prev. Sanitation Permit# ----_------------------------------------------ Date ____.----------•-------..-----1 Septic Tank (Specify Requirements) ------------------------------------------------------*-----------------------------------------------------.----------------------------- Disposal Field (Specify Requirements) --------------- ;; ---------------------------- Y ----------------------------------------------------- ------------------------------________ ________ _ -_____-_____.__..____________________________-____.___-_____________________-__._______.__--_----.______________- -.___ (Draw existing and required addition'on reverse side) I hereby certify that 1 have prepared this application and that the Y 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: "1 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 lawsf alifornia." Signed ---------------------------- -------------- -- ---------- --i --- ----- -- ----------- Owner , By --- ----------- ----------Title - ---------------- ----------------------- - -------------------------- - ---- - ------ ----- - - - - (If other than owner FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY --.- --r- - -------------------------------- ---------------------- DATE 4°"//^ ------- BUILDING PERMIT ISSUED ------------------- ----------------------- --------------DATE ------------------------------------------- ADDITIONAL COMMENTS ------------------------ --------------------------------------•------ --------- --------------------------------------------------------------------------------------------------------------------- -------------- --------------------- - --- ---------------------------------------------- ------------------------------------------------------------- s ---------------------------- -- _ -------- ------- ---------- - --- Final Inspection b): _ C.l-.tom-- Date ____ �7- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M