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F FFICE USE: APPLICATION FOR SANITATION PER ----- -- -- - ------------ --- i (Complete in Triplicate) Permit No. i ---- ............................. Date Issued _. .3� ..... - ---------------------------- This Permit Expires I Year From Date Issued licati n is hereby made to the San Joaquin Local Health District for a permit to construct I may D w herein ' This application is made in compliance with County Ordinance No. 549 and existing ales an egul ions: t Zt) ��-v CENSUS TRACT i JOB ADDRESS/LOCATION _3-.L-7.-- Pr - ---------- ------------- �, - ------------- Owner's Name -------. -_6:v '•---`----=-----=--•---•------------ ---- ------- ---- ------Phone ......... ----------------•---- Address -- ---- --- - `f `7 J GL) � �--- ,�cl- - City ----- -----------r`---- - ---- ------ -------• ---------------------- Contractor's Name --------------------- Contractor shame - ---- -------------.... -------- --- -------------------------------- -- -. License # Phone -..................... Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer'Court ;❑ l Motel ❑Other Number of living units: ----------- Number of bedrooms""' ----- arbage Grinder ..... Lot Size�c-_F ::-z: �-G= --------------- Water Supply: Public System and name - ------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam r,4/ Clay Loam ❑ i 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,) V ' I PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth .......................... N Capacity -------- Type -------------------- Material---- - No. Compartments ---- --------- Distance to nearest: Well ------------------------------------Foundation ------------------ Prop. Line .-.------------------ LEACHING LINE [ ] No. of Lines ----------- Length of each line---- .- ......... ------ Total Length ...........................: 'D' Box ............ Type Filter Material .-------------------Depth Filter Material --------------------.----------------------. Distance to nearest: Well ------------------------ Foundation ... --------------------- Property Line _-. ................... SEEPAGE PIT Depth ............. ------ Diameter --------------- Number --__.----------------------- Rock Filled Yes 0 No ❑ Water Table Depth ------------------------------------------------Rock Size ---------------- ------ Distance to nearest: Well ----------------------------------------Foundation ....---------------- Prop. Line -..................... i REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------- --- ---- --- Date --------- ----------.-------------) ] Septic Tank (Specify Requirements) ------------------------------------------------------------------------- -- n Disposal Field (Specify Requir ents) ....;--------------------------- ------ ------------ :: ------ -------------------- - --------------- ----.- i i �'L� ---------------/(_� Lam/ j V V _.�I y - .. .._--- f ------ ---------------•-------- - j ---- -------- ----------- - ------ -- -- - - --------------------------------- -------- ---------------•------- ------------------ -- -- ------- - - - - - - - - - - (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: I "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 mpensation laws of California." Signed - ----- - n J G. Ower 67 Y - ------ --------------------------- (If other than owrier) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. DATE .-Z.'.-"-:.r- -•`-- - '--- - ------ BUILDING PERMIT ISSUED ----------------------- - . ----..:--------------DATE -------- --------------------------....... ADDITIONAL COMMENTS ------- ---------------------------------------------------------------------- ----------------------- ----------- - --------- --- --- -- - --- ----- i' - -------------------------------- ----- -------- ---------------------------- Final Inspection b�:_ - - SAN JOAQUIN LOCAL HEALTH DISTRICT y {". �� - � p - ---!-[r .- ,r�_r4 1. Date =` -- ------... + ------ E. H. 9 1-'68 Rev. 5M