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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------ -- ----------------------------------------------- Permit No. - -_9 - (Complete in Triplicate) --------------------------------------------------------- This Permit Expires 1 Year From Date Issued 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 complian a w't aunty Ordinance No. 549 and existin Rules and Regulations: t kt C-�tJA- 3 3 / / :. 2 ex,&t i s CA�% A JOB ADDR5SS/LOCATION --=------��4,h-o------� W:'� �`'� - ('-�.e�nr�-----CENSUS TRACT ------------- - Owner's Name --------------Phone -----------Z--------------------- i Address ------------------------------------------------------ ---------------------:--------------------------- City -------------------------------------------------------------------- ... Contractor's Name ---- •__.! '-!1//_!)__ _ --- ---- t' _____________________.License #/ 6✓ 6-_--- Phone 5��3__"C------------- ------------------------------- �` - Installation will serve: Residence [-]Apartment Mouse❑ Commercial: rraller Court ❑ Motel ❑Other --------- ----------------------------------- /� Number of living units:------------ Number of bedrooms -------------Garbage Grinder -------- --- Lot Size _-__________/.Q4--------------------- __ Water Supply: Public System and name -------------------------------•---------------------------------------- •----- ------------------------------Private Character of soil to a depth of 3 feet: SandF] Silt❑ Clay ❑ Peat❑��tt,,��/i.�_-Sandy Loam ,Z Clay Loam ❑ Hardpan E] Adobe '❑ Fill Material ---�1If 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 [ ] SEPTIC TANK j ] 5ize_' ' 'r!r--a____________________---_----- Liquid Depth ---_f'�___................. Capacity 1 v-v W Type &4Z_-CAN'T Material_C'PW()rF P No. Compartments ---i;�_______---.-•-- Distance to nearest: Well _____ fU-a__________________Foundation ____J_ __�________ Prop. Line ___` _.____ LEACHING LINE [ ] No. of Lines ____ ________________ Length of each line------4�,:V--------.------ Total Length ___a_ .p is a f 'D' Box ----/...... Type Filter Material Depth Filter Material ____ _______________________ Cyd --4�------------- Property Line ---/4'- ..---_...-- Distance to nearest: Well --__a�________________ Foundation ____4? . . (;t SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number - -------------------------- Rock Filled Yes ❑ No i❑ `r11 Water Table Depth ------------------------------------------------Rock Size -------------------------------- �l3 Distance to nearest. Well ___________________.___________-___....Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit F# ________________________________ Date ----------------------------------I SepticTank (Specify Requirements) ------------------------------- ----------------------------------- --------------------------•---------------------------•- Disposal Field (Specify Requirements) ----------- ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ ------------- ----------------------------------------------------------------------------- - ----------------------------------------- - - . —1-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 Ileen- 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 fy'/Y !!,a'ny- v----:- - --------------------------------- Owner By ----- - ----------------------------------------------- Title �1 . r -------------- ------------------------------------- (If other t -ewr'lerM FOR DEPARTMENT USE ONLY ------- --- APPLICATION ACCEPTED BY -------------------------- ---------------------------------------------------------------------- D TE ---/) ----------------- BUILDING PERMIT ISSUED ------------------- ------ ATE -----------__ ADDITIONAL COMMENTS --------------- --------------------------------------------------------------- ----------- ---------------------------=--------------------------- ------------//"--��-- ------- ------- Final Inspection bY= ---------------------------------- -- ate SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M