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FOR OFFICE USE: k z- APPLICATION FOR SANITATION PERMIT ----------- ------------------------------------- i Permit No. --7 z.l-- r p/ (Complete in Triplicate) -�Q ;�. -------------------------------- ------ 3 7 v �• Date Issued -- This Permit Expires 1 Year From Date Issued F 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 mad��pliancee//with County Ordinance No. 549 and existing Rules and Regulations: CENSUS TRACT JOB ADDRESS/LOCATION . __ - __r _ Owner's Name - ��r�� u r - ------ Phone .---------------------------•-- Contractor's Name-- 4PZ�--t-`/ ------------------------License # ----------- ------ Phone ---------------------- ----•-- Installation will serve: Residence [Apartment House❑ Commerciaf ❑Trailer Court i❑ Motel ❑ Other ------------------------------------------•- Number of living units:-----/__.. Number of bedrooms ______Garbage Grinder V1d0e__!P Lot Size ----------- --- Water Supply: Public System and name ------------------ ----------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'D 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,) `, Q ,�-+ Liquid Depth - --- ---------------- O PACKAGE TREATMENT [ ] SEPTIC TANK: iz� ,X ---+7----------------- q P ,' f `ky i 'Material �7 _"_ No. Compartments _._�''_--._-_.___ Capacity/ .____ TYP�� Distance to nearest: Well ____.___�'a-_!_t__________.Foundation __,f.'e--f--_-___ Prop. Line,,? ._ _._.... - LEACHING LINE [ No. of Lines ------- ___________ Length of epch line-_ :---.------ Total Length ., / 'D'4 Box __:-P Type Filter Material // / epth Filter Material __ p___________________________•--.... �! i bistanc to nearest: Well __ ._�_____ _____ Foundation ... -I ------- Property Property Line ........ SEEPAGE PIT Depth _ Diameter �1 Number .___- . _._ - _.--_- — _____________ Rock Filled Yes ;[�' No-C] Water Table Depth f - - _ Rock Size _ i. �' ` Distance to nearest: Well ___ 4s_ ___ _,t_,_,...Foundation _ - -------- Prop. Line 115..1.... ........ REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date ..........-_---------------------- Septic ----.----_--- ------Septic Tank (Specify Requirements) --------_--------------------------------------------------------------- -' Disposal Field (Specify Requirements) ------------------ -----------=--------=----� ---'--------------------------- -----•--------------- --------------------------------------------------------------------------------- ----------------------- (Draw existing and-required addition on reverse side) 1 hereby certify that I have prepared this application land 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 become subject to Workman's Compensation laws of California." Signed ---- - --- ------ ---------------------------•Owner By _____ 4 Title `�� ------ ----------------- f , f other t an o ner) F R DEPARTMENT USE ONLY 4 �. APPLICATION ACCEPTED BY r ' ----- ----- DATE - � �' -------------- BUILDING PERMIT ISSUED --------------------- ----/---------- ------------------------------DATE ------------- ----------------------- ---- --- -- ------------------- ADDITIONALCOMMENTS ---------------------------------------------------------------- ---------------------------------------------------------------------------------------------- --------------------------- ----I----------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- ----------------------------------------------------- ------------------------------------------------------------- ---------------- -------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- ------- FinalInspection bY- -- -------------------------------------------------- ---------------------------------------------------7------Date -------- ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �.