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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ___ Permit No. (Completg in Triplicate) --------------------------------------------------------- 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 wi Cou ty Ordinance No. 549 and existing Rules and Regulations: • JOB ADDRESS/LOCATIONi�, t�� ---------------CENSUS TRACT ______________________.. ---- -- Owner's Name ----- --- -- - - ---- -------------------------- -----------•------- Phone --- Address ------- S Z -- -------- ----------------------------------------------•--. Ci�� i city ------------------------------------------------•---•--•-----•--•----•------ Contractor's Name --- •13-7-S-------------------- --- ---------------------------License # ------- -.- ------------- Phone ------------------------------ Installation will serve: Residence TrIkpartment House❑ Commercial []Trailer Court ;❑ Motel ❑ Other -------------------------------------------- Number of living units------l------ Number of bedrooms _J--------Garbage Grinder _!�---- Lot Size -___________________ Water Supply: Public System and name -- ----------------------------•----------------------------------------------------------- -----------------Private �. Character of soil to a depth of 3 feet: Sand`E] Silt Gay ❑ 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,) PACKAGE TREATMENT [ I SEPTIC AN Size-------------------------- ------------ Liquid Depth -------------------------- Nk Capacity - --------•-- Type -------------------- Material---------------------- No. Compartments ---------------------- Distance to nearest: Well Z--------------------------------Foundation --------- ------------ Prop. Line _O_�___:__------ LEACHING LINE [jr-"No. of Lines _____L________________ Length of each line---�U_----------- ------- Total Length ,____ ____.______________.. 'D' Box C __ Type Filter Material _�L14._..Depth Filter Material -Ilk------------------------ Distance to nearest: Well _Lu o _--__________-_ Foundation 1 ----------------- Property Line _-'�_________--------- SEEPAGE PIT Depth __.45---------- Diameter __3-3_ __ Number ---/---------------------- Rock Filled Yeses' No Water Table Depth ---Ez-0---------------------------------------Rock Size - --- ------------------ Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -----------------•__-. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic (Specify D sposal Field (S(Specify Requirements) -_----- .--`---- ---------- ------31X2 ----------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addion reverse side) I hereby certify that I have prepared this application and that the rk 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------ ignedOwner - ---------------------------------------------- Title --------- -------- --------------------------- (If other than owner) FOR DEPA MENT USE ONLY APPLICATION ACCEPTED ---------------------------------------- DATE _ _'� 6 BUILDING PERMIT ISSUED ------- _ --•_-- ,--" _ DATE ADDITIONAL COMMENTS - _ ' `�' - R---- ---- - -- -- ----- =- - - -- - - - - - -- --- - ---- - - - - ------ --------- - ----- ''c,b F �'`� V,,� - " � a - �;,+� p 7 Gly- -`i' r Fina In ection b YY-s _'____ Date _ _ Y: -- °'� -- + fs--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M I