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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ Permit No171. ---------- ___- (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 compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION . _ _____..._��`'I ___._ __�___� --CENSUS TRACT Owner's Name ----- G --------------------- ...........hone +� - Address ---------------1-- G----�-- GAJ - City ; _� Contractor's Name -------------------------------------- -----------------------------------.License # ------------------------ Phone -----------------------_----- Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ------- ----------------------------------- 6 Number of living units:_ Number of bedrooms . __.___Garbage Grinder ---------- Lot SizeD U--____--___- Water Supply: Public System and name --------------------------------------------------------------------- ------Private [ Character of soil to a depth of 3 feet: Sand'[X Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam4 Hardpan ❑ Adobe [,V 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 [ ] SEPTIC TANK Pq Size------------- �p�- Liquid Depth ------ F -2—------- 0��4 Capacity __� -C�`� "Type /j-f Ad/ Material___ __2_'LG�__ No. Compartments .21 Distance to nearest: Well .__(, ---_______________Foundation/--41-/----------- Prop. Line ----ul_. .... LEACHING LINE [ ] No. of Lines --_ ------------ Length of each line------- _ -------- Total Length ,�4'9� 'D' Box __✓__ Type Filter M terial`g� �t_ __fleptl� ilter Material _-- _9_�� . //`` Distance to nearest: Well --___ ----------------- F undation ___l __f-.__.__. Property Line �___...___. SEEPAGE PIT [ j Depth J-6----------- Diameter ___fit__/x_ umber _____�________-_-_. _ Rock Filled Yes [W No 0 /i f -- Water Table Depth _ . ._ LS_ ____________________•-Rock Size __!___ __�t__. '________ Distance to nearest: Well -------_�-e7------------- - --/-4/------- Prop. Line ---__�....._....... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) SepticTank (Specify Requirements) ------------------- ------------------------------------------------------------------------- ----------- -------------- ------------------- Disposal Field (Specify Requirements) -_-_____-___ __________________________________________ ------------------------------- --------------------- -------------------------------------------------------------------------------------------------------------------------- ------------------------- ---------------------------- ---------------------- ------------------ ---------------------------------------------------------------------------------------------------------------------------------- (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: "1 certify that in t performance of the work for which this permit is issued, I shall not employ any person in such manner as to bec m sub' ft to Workman's Com ensation laws of California." Signed - -----A/- - - ------------------------- Owner By --------------------------------------------------------------------------- ------------------------ Title ----------- ------------------------------------------------------------ (If other than owner) 00 FOR DEPARTMENT US ONLY APPLICATION ACCEPTED BY r ----- - --------------------------------------- -7DATE L BUILDING PERMIT ISSUED ------------ -------------------------------- -------DATE ------------------------------------------- ADDITIONALCOMMENTS ------------- -------------- ------------------------------------------------------------------------------------------------------=--------- ----------------- -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- --- -- ------ _ ----------------------------------------------------------------------------------------------------- FinalInspection by: . - - ---- --- -------------------------------------------------------------------------------------------Date --------- - ---- ---------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M