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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------- --- ------------------ ----- Permit (Complete in Triplicate) x ------------------------------------------------ This ---------------------------------------- ----- ��- � Date issued This Permit Expires 1Year From t to construct and install the Work---------- --- ---- ------------------------- ------- 1 r Application is hereby,made to the San Joaquin Local Health District p herein described. This application is de'n complia ce with County Ordinance No. 49 and ex)-sting Rules and Regulations: JOB ADDRESS/LOCATION -- � � '! - --- -- CENSUS TRACT ---------------- . Owner's Name q --tn i---- ------------------- -------Phone _'il��-`-S�C?-g _ Address - a!+ fJ�---------- City r� �j I !l Contractor's Name ____ _ _ 4 __--_ _ _ _ -------.License # 1 �----- Phone 7 �_ !� _�__ Installation will serve: Residence❑Apartment House, ]'Commerci6l ❑Trailer;Court ',❑ Motel ❑ Other } Number of living units: __ ,.,,_,; Number of bedrooms �r ge Grinder _.______-_- Lot Size - _ --- '--- - r , Water Supply Public System and name---4r---------------------------------= ---------------- - ----------------------------- ------------Private Character of soil fo a depth of 3 feet_ 'Sand'[:] IrSilt❑�, Clay ❑. " Peat❑ Sandy loam X Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If ye`€, type ---------------------------- (Plot plan, showing size of lot, location=of-system•in relation to-wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} r . PACKAGE TREATMENT [ SEPTIC TANK Size_ 1 ! _ ------------------- Liquid Depth -----_e7---------------- } , Capacity /�6-0_-______ Type _ _ Material_ No. Compartments ______il ...___�. r + Distance to nearest: Well ______6_z�--------------------Foundation' ------------- Prop. Line LEACHING LINE �6 No f Lines ------- ---------- Length of each line-e7e---- -_ Total Length ___ ___.__----__ 'D' Box ____V____ Type Filter Material !_ adeDepth Filter Material --------/_.Q_____________r. ._ Distance to nearest: Well __ ---__---____ Foundation,-90 Property Line. _5...... SEEPAGE PIT' [ ] Depth I- ------------- Diameter ---_____________ Number Y__-________-_-__--------___ Rock Filled Yes ❑ No i❑ 3 Water Table Depth --------- ---- -- Rock Size Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line -----__-----------__-- � � iI REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------- Date -----------------___--------------1 t t1 } t SepticTank (Specify Requirements) ----------------------------------------------------- --------------------------------------------------------------------------------.. Disposal Fie (Specify ReuireHients} .._ p Y q ---------------------------------------------------------------------------------------- -------------------------- � f ------------------- 1 -------------------------------------------------------- --------------------------------------------------------- -------------------------------------------- ----------------------------------------- (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 as to beco suWect to Wo;kmCompens 'on laws of California." f 1 Signed -- ------- - -------------- Owner - r • r BY ----------- ----------- Title ---------------------- --------------------------- ------------------ e -- - ----------- (!f other than o erl 6101'�'IFOR DEPARTMENT USE ONLY f6 1I APPLICATION ACCEPTED BY . --- - -------------------------------------------------- DATE - / BUILD[NG PERMIT ISSUED - ----- -- -- --- ------- DATE ------- ---- ------------- ' ADDITIONAL COMMENTS __________________________________ ' � 0-* ---* --=--------------------------------------------------------------------------------------- "C' ----------- -------------------------------------------- ------------------------------- --- ------------------------------------------------------------ - - ----------------------------------------- .. i 1 - - - -------------- --- - -- --- --- ------- ------- - ------------ - ------ -------.Date -------- / 7-- ----- I Final Inspection by: __ =----- 5AN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M