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t jR OFFICE USE: APPLICATION FOR SANITATION PERMIT � Permit Na. i --------------- ------------------------------- - (Complete in Triplicate) ---------------- ------------------------------- --- - Date Issued This Permit Expires l Year From Date Issued , Application is hereby made to the Sa Joaquin Local Health District for a permit J6 construct and install the work herein described. This application is made in compliance with Cnty �anc o. 549 and existing Rules and Regulations: ! h �► --- -- _---- --CENSUS TRACT --------------- JOB ADDRESS/LOCATION':40-7— _ _ u = �� .J s e_ �'-----------------= -------------------- //�� �} Phone �---j---------- Owner's Name f"t }✓f - ----- � W _ _ � ------------ Cit - r, �. Address � - ✓ - Y�- ---��__._Gc3f�'�--�-----------------•------.....-- ` ------ Phone Contractor's Name _.._J(./e�� _ I1 T =' =.License #=" Installation will serve: ; Residence ❑ Apartment•HouseF❑ Comme cr al ❑Trailer Court ;Q Motel E]Other -------- -----l------- -------------------- i �- Number of living units-,_-!_- --- Number of bedrooms _]/-__---Garbage GrinderkPlQ' Lot Size __�---_--- - �] -----------• Water Supply: Public System and name --------------- Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay E] Peat E] Sandy Loam ❑ Clay Loam ❑ -4— - Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- f ' {Plot plan, showing size of lotwasilocatio'n .of system in relation to wells, buildings, etc. must be placed on reverse side.) ' septic.tank or seepage pit permitted if public sewer is available within 200 feet,) ! I PACKAGE TREATMENT ] SEP p b y.-�? •��-- NEW INSTALLATION: (No se tic p ,T1C TANK' Size 1 crJ -` ` Liquid Depth 14--`--'----------. i Q Type __ e_ S �- Material -t No. Compartments CaPQ4�Y:i Yp P ---•------ f (� rDistance to .nearest: Well ___ ------ --------------------Foundation --- ----i-_--------- prop. Line _, ------ -_-- L E Ili L } ------ Total Length -------- G "D' Box W---:-"Type Filter Material. 4"--_Depth Filter Material ___ --------------------------- ------ J�/ G Distance to nearest: Well ____ ` Foundation ____ __�.___________1 Property Line- -�______________-____ 7' ` _---_ Rock Filled Yes ❑ No SEEPAGE PIT [ ] Depth -----------------=-- Diameter ---------------- Number ----------------------- ...� ._ Rock Size -------------------------------- Distance -----------------------•-- Water Table Depth �� ---------------- --- �--------- ----- Distance to nearest: Well ----------------- ------Foundation -------------------- Prop. Line ------------_------ REPAIR/ADDITION -----------_---REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------.-------------------) i Septic Tank (Specify Requirements) ------ ------------ ----------------------------------------------------------_---------------------- -•- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- -----------------------------=------------------------------------- -------------------------- __ ___ i ----------------------------- (Draw existing and required addition on reverse side) 1 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 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Campens ion laws of California." i ------ Owner. Signed __.�✓�'v�^�''.�- �--��r-.�-------------------- - ------------------- Title ---------- ----------------------------------- ---- -------------------- (If other than owner) k EPARTMENT USE ONLY APPLICATION ACCEPTED BY _______ _____ DATE __. _— _2—-- :----- BUILDING PERMIT ISSUED -_- _ DATE --------- -------------------------------------- ADDITIONAL COMMENTS _.: - ---------------------=---------- ----------- ----- ------- ------------------------------ -- --- e1__ --------------------------:-------- ------------------------------------------------------- __._. -------- Final Ins ection b ------ ----------Date _ ------------------------------- SAN JOAQUIN . LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M