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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- ------------- ---- ------ Permit No_ _ ___994 (Complete in Triplicate) ___7____ _._. ---------=----------------------------------------------- Date Issued .9-_ �__�l � -----------------------------------------__------------- This Permit Expires 1 Year From 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 CounfiOrdinance N e nd existing Rules and Regulations. JOB ADDRESS/LOCATION .o,_ -- --------e-- -------------------------------- -------CENSUS TRACT ...... ------- --------- Owner's Nam ---Phone -------------- Address ------ ----C �T ---------------- City .1-- _------------------------------------------------ Contractor's Name ...- �/Apartment -- _ ----------- -----------------License # � _ Phone ----------------------------- Installation will serve: Residence House❑ Commercial ❑Traiter Court ;❑ t ` Motel ❑Other -- Number of living units:----- --- Number of bedrooms . ------Garbage Grinder ------------ Lot Size ___________________________.__________._._ Water Supply: Public System and name ------------ ---------------- ------------- -------------------------------- Private [ � Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E] Peat El Sandy Loam Clay Loam ] Hardpan ❑ Adobe ❑ Fill Material ____,______ If yes, type ____________________________ i (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 wit6n,,200 feet,) PACKAGE TREATMENT [ } SEPTIC TAMC f ] Size-------------------------------.-----_1--------- Liquid Depth ---------------------__-- Capacity -------------------- Type -------------------- Material----------=�=-u�,_.:,;;N�.- Compartments ------•-------••------ Distance to nearest: Well ________---_----------------------- ._ p` ' --Foundation ---_-__-.3_>._—"Pro Line ---------:`=-'-=----- LEACHING LINE [ ] No. of Lines ------------------------ Length-of,ea`h liner_.___-' `"_'__---- Total Length .______-____-_ 'D' Box ------------ Type Filter Material ___________________Depth Filter Material --------------------.________-______-4444 Distance to nearest: Well ------------------------ Foundation -------------------- Property Line ---------.-------------- SEEPAGE PIT [ ] Depth --- ------ ------------ ❑ [ ____________________ Diameter _ Number _4__4__4__4.._ Rock Filled Yes No ' Water Table Depth --------------------------------------- -_—Rock-Size-------------------- ----------------- ; Distance to nearest: Well --------------------------------4----------Foundation -------I------------ Prop. Line ____.____-_---_-_____ REPAIR/ADDITION(Prev. Sanitation Permit# ________________ t ------------ Date ---- ------------=--------------) � [ i Septic Tank (Specify Requirements) --------------•------ --------------------- ----------------------- ------ ----------------------- Disposal Field (Specify Requirements) --------•----------------•----••---------4---------- -------------- -------•------ --------------- ------------------------------ -- --- -.------------ ----------- ----------------------------- -------------------------- -- -- ------------- -------------f---------e------------� - e �'"' later (Dr�ting aa6d required a ition 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 as to becom su ect to Workman' ompensation laws of-California. Signed --- -- - Owner -------- ---- By � r - Title. -,- ------------------------------ (If other than owner) FOJt DEPARTMENT USE_._ONLY . .__ �- APPLICATION ACCEPTED BY __/ __ __ - ___.-_-. DATE __. -- -- -- ------- - ------------------------------------------------- - ---776-J/_--------------- BUILDING - -- ------------------ BUILDING PERMIT ISSUED ---- ------------------------------------------------------- -------------------------------------------DATE ------- ----------------------------------- ADDITIONALCOMMENTS -------------- ----------------------------------------------------------------------------------------------------------------------------------------------- ... Final Inspection by: Date _---". ----- ---- - -- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M