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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------ --------------------- -_------ C� __ - (Complete in Triplicate) Permit No. ' V This Permit Expires 1 Year From bate Issued Date Issued __�- ----------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install"the work described. This application is made in compliance with County Ordinan No. 549 a d existing Rules and Regulat onsre1n JOB ADDRESS/LOCATION(. �,3_ he f G f�' F��,�/ CENSUS TRACT Owners Name -___-- --•--- ----- f�� _.__ •-- Phone Address - --��- �- '----------- ----------------------------------------------- City .�. V_ Name _- ��' �� y------------------------- ----------License #�,��,�f� Phone��r�'��',�� Installation will serve: Residence @ r artment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -- --- - ---------- Number of living units:-- ------ Number of bedrooms -.-?--_--Garbo e Grinder . _ - -g . __ Lot Size Water Supply: Public Syste and name _____ ___ _ _ __ _ ____ ____ Pp Y� - - - - -- - - - --------- - - _ Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ ' Clay ❑ Peat.❑ Sandy Loam C]- Clay Loam ❑ a Hardpan p P �Adobe'❑ Fill Material ------------ If yes, (Plot plan, showing size oft lot, location of system in relation to wells, buildings, etc. must be placed on reverse side. NEW INSTALLATION: l } (No`septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK-ICASize_ _ffii G ------------------------ Liquid Depth -- Capacity Type Material�i�� -- -______ No. Compartments �--, Distance to nearest: WeH o ----•----------------- Zr------------ ----------Foundation ------------- Prop. Line _ LEACHING LINE No.1of Lines - ---------------- Length of each line_. ------------- Total Length ,edl -----•-•------ s D' Box;e/t! � " Type Filter Materia I�, ( , r Depth Filter Material Dishn nearest. Well `' `----------- Foundation p4p—�`" --__--_-" Pro e Line SEEPAGE PIT ti P rtY -��... ........... — ] Depth a ---- Diameter ------ Number _-s'-------------------- Rock Filled Yes No Wat�r Table Depth Rock Size � � p ------ — - -------- ------- 110, ------------- -- Distaince to nearest: Well _--_ __ . may. ,� ------------"_-.._ Foundation --f'..Zt3--- Prop. line /�, '.-.----- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- ' Date ------------------------ Septic Tank (Specify Requirements) ---------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------- -- ------------- ------------ ---------- ------------------------------------------ ---------- ;=- (Draw existing and required addition on reverse side) i ----------•- I hereby certify that I have prepared this application and that the work will be done n 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 "= ---- I Owner --------- 1 ------------------------- BY ----------- ----- -` ---'rc title ---------- 4��--------------------------- (If o tn owner] J!. FOR EPARTMENT 615E ONLY APPLICATION ACCEPTED BY ,I______ __._ BUILDING PERMIT ISSUED iM - DATE `3 ------- ----- ---•---------•--------- - ---------------------- DATE ---------- --------- ------------------------------------------- ------- -----------------------------------------------=------- ---- ---------NAL COMMENTS --�M----- .- - ----------- ----- --------------------------------- -- ----------- -"---- ---- - - ----------- --------------- ---------------- ---- --- - - - -------- - - -- - ------------ •Final Inspection by: ------------------- - -------- --------- -- ------- ----------- -------- ----------- ----- ------- -- -------Date -------- ---- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev.'5M I� +