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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT v �, --------------------------------------------------------- Permit Na- -7----L-�--- (Complete in Triplicate) i ___________________________________________________-_ 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 andAENSUS ' tjng Rules and Regulations: JOB ADDRESS/LOCATION . _P `� __ --- TRACT __________________________ J . E Owner's Name ------ � ------------------------------ -------Phone ------------------------------------ _ f Address __. ,_ .1 , - ------------------ City �-------------------- - r Contractor's Name �pjj_i_�_____________________________________License #o?Yl- tf Phone Installation will serve: ResidenceXApartment House[] Commercial :❑Trailer Court i❑ y,. tMotel ❑ Other ----------------- -------------------------- Number of living units:________ Number of bedrooms --------Garbage Grinder ___ Lot Size90K��'---1—`--------------- Water Supply: Public System and name ---------------------------------------------------------------------------------------------------- Private, Character of soil to a depth of Veet: r 6nd'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam "❑ i y Hardpany 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 s9ewer is available within 200 feet,) PACKAGE TREATMENT { SEPTIC TANK Size__ _ , _______________ Liquid Depth �� .ry �--------------. CapacityfCg� _---r�_ Type -- � _ - MaterialOfAV �___ No. Compartments _--f— Distance ,to nearest': Well �1 -----------------Foundation __ V___.________ Prop. Line . _-00_____.___ LEACHING LINE No. of,Lines ----- ------------- Length ofach line,,_� g �r _____-____ ___L� ----- ------ Total Len tFid.��___-- E 'D' Box .d _ _ �fype Filter Materia ''�� Depth Fifter Material ___ ___________________ _______ j/ Distance to nearest: Well _7�_.__ _____ Foundation / ___-_______ Property Line:*��_____________ SEEPAGE PIT' Depth t f-� _'___- Diameter � Number ___ ___________ ------------ Rock Filled Yes, ' No I❑ ________ 4• oe i Water Table Depth - -- ------------ ` � _Ole, 'I- � � ` Roc Size _________ iDistance to nearest: Well_._-__/` ___ _______________Foundation __ ___ ___._____ Prop. Line.,0-_____-__-_--- I .-. - A y REPAIR/ADDITION(Prey. Sanitation Permit# __________________�_- ------- ----- --- Date -----------__-___-_--------------- Septic Tank S ecif Requirements) - ------------------------------------------ ------- --------------- )- ---------- --------------------------- DisposalField (Specify Requirements) -------------------------------------------------------------------'---------------------------------------------------------------- - i ----------------------- (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 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner i as to become subject to Workman's Compensation laws of California." Signed --- 4xJ - Owner ,_ , . A ----=-=------------------------------- BY ------ -- i-------------------- TitIe 'f '"`- ather than owner) ' FOR DEPARTMENT USE ONLY +� APPLICATION ACCEPTED BY - DATE / ` ~ - - ------------'-------='"-•------------ BUILDING PERMIT ISSUED ------ ------------ ----------------------------------------------------- " ------ --=-----------DATE - ----------------------------------------- ADDITIONAL COMMENTS --------------------------------------------------------------------- ?1 ------------- -------------------------------------- ---------- -----------------------------------------------' ---------- ---------- ----------------------------------------- - --------- -------------------------- - ---•------------- . --- - - ----- Final Inspection b ------Dal _ --------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M