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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --: ----- --- (Complete in Triplicate) - Permit No. _....a_��f��__. ._......_•.............................................. 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 herein described. This application is made'in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION °Z .�! _ _ar. -- _-- _ rnJ- _--- ---CENSUS TRACT ---q_ 4............. Owner's Name �``f"� �/+ = ----------- ---- = . _ --•-..Phone Addres = Y U �`"h { Contractors Name -_- -•- Let-- �� --- - •r - -.......License# --.--------------Phone _ _l� _ _l. Installation will serve: Residence portment House Commercial [-]Trailer Court i❑ Motel ❑Other---- --------------------------------------- Number of living units:............ Number of bedrooms ,:_ ._Garbage Grinder .._ ........ Lot Size .... a.. ° c4'------.____-__- Water Supply: Public System and name -----------------------------------------------___-------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'o Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam❑ r Hardpan ❑ Adobe'[] Fi I 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,) 'r PACKAGE TREATMENT { ] SEPTIC TANK T ] Size............ ------------_-- Liquid Depth _____.__-____----. Capacity - ----------------- Type -------------------- Material................------ No. Compartments ................. Distance to`nearest: Well ------------------------------------Foundation ---------.------_.......Prop. Line ....---._.------------ LEACHING LINE [ ] No. of Lines ........................ Length of each line_.----------------.--------- Total Length ----------------_----_---- V _____.____--_..._---._ ----'D' Box .------.-.-- Type Filter Material --------------------Depth Filter Material .............................................. �1 Distance to -nearest: Well -- __________________ Foundation ------------------------ Property Line ........................ SEEPAGE PIT [ ] Depth ....... ............ Diameter ________________ Number .____.._.._....._.. ........ Rock Filled Yes ❑ No ] Water Table Depth ------------------------------------------------Rock Size .. ------ --.................... Distance to nearest: Well ........................................Foundation .................... Prop. Line --------------------- REPAIR/ADDITION --_"f-REPAIR/ADDITION(Prev. Sanitation.Permit 9A............... .. Date .......... .........,.-_-_-__-- Septic Tank (Specify Requirements) ..... - .-�p�.:e.� �s.�"�"„�.d----- - ---- �--- -- _- ;•----- --•-• �,-- K- _ Disposeld (Specify Requirements) _____________________________________________;_.__._ ___ -� _ - - - , --------------------�--------------- ------•- .---_-------------------------------------------------,.w__.__'"--__ .----: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 atcordance 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 laws of California." Signed ---•---------•--._ -_ .................. - ------ ,. � Owner -" Title ----- - ------------------------- ------------By . s /� t an owner) + /,FOR DEPAXTMENT USE ONLY APPLICATION ACCEPTED BY _. _.._. __.' ........... .. .• ------------------------------ DATE ./ ............... � .BUILDING PERMIT ISSUED ............... ........ -------DATE .:----------.-----------------------------r" ADDITIONAL COMMENTS -----F - -- ------•--------------------------------- ,a 4 •...... . . .............................. ! _____________ _____ ___________ _________ __•._•.--._-__--._ ..--.---•.-----._-_.•----•-._•_-.____-__________________________--_-_- .______-_ Final Inspection by: - Aate/s� �f" ---------_ l SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M