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FOR OFFICE USE: -------------------------=---�` .. -—APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) This Permit Expires 1 Year From Date Issued f Permit No. Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 :/.O,7f1D---_.;Ii*,�1i ----- � C / -'----CENSUS TRACT -------------- ----------- Owner's Name %------------------------------------------------------------Phone --------------------••-------------- T.Q_4- L�QX5j City /�t�—� Address j} --•------ Contractor's Name ---[� �le l4 rC - . ----------- License # Z_1VV7&--- Phone Installation will serve: Residence ❑Apartment House❑ Commercial : railer Court ;❑ Motel E] Other /~',-- --1/� �4,611 Number of living units:_A1 --- Number of bedrooms 0: ---Garbage Grinder 110----- Lot Size --- '_-_._______ Water Supply: Public System and name--------------------------------•----------------------------------------------------------------------------- Privat Character of soil to a depth of 3 feet: Sand Silt ❑ Clay ❑ Peat..❑ Sandy Loam -❑ Clay Loam ❑ 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,j i PACKAGE TREATMENT [ I SEPTIC TANK'[ ] Size------ ------------------------- Liquid Depth --- r__. - Capacity Zoao--------- Type- --_-.?�-_ __ • Material-_-Ae' dw - No. Compartments -----_--_ f Distance to nearest: Well ----- /BE? --------------------- Foundation ------------- Prop. Line---�-._....--.... LEACHING LINE [ ] No. of Lines ___T --------------- Length of each line ------ /Q2457---------- Total Length --_--__--_-__. 'D' Box-.--- Type Filter Material 1 5X --- epth Filter Material ----1411' -------------------------------- Distance to nearest: Well ---/,0-0------------ Foundation _/0 --------------- Property Line _S-------------:.-__ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number .--------------------------- Rock Filled Yes ❑ No.c] Water Table Depth ------------------------------------------------Rock Size --- ---------------------------- Distance to nearest: Well ---------------------------------------- Foundation •-------------------- Prop. Line -_----_-__---_-...__.- REPAIR/ADDITION (Prev. Sanitation Permit # ------------------------------------------- Date -_--_---_---------_--___--_-__-_j Septic Tank (Specify Requirements) --------------------------------------------------------------------------------------------------------------------------------------- i k DisposalField (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 Incen- 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 bject to Workman's Compensation laws of California." Signed --------- --------------- ------ Owner .. Title ---------------------------------- BY - .a.t�te-ea� (If other than o er} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- -- __--- — ----------------------------------------------------------------- DATE --- l -` !� - � ............... BUILDING PERMIT ISSUED-------------------------------------------------------------------------- ------------------------------DATE ------------------------------------------- - ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------- ------------ --- --- --- -------- Final Inspection by: _ Date --/--_j—�:�::-=_ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 ,.1-'68 Rev. 5M' G;