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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- --------------------------------------- -- -- --- Permit _- (Complete 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 with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO TION . � .9--.11f_�--. -_ -P,�,a. I ------------- �'. CENSUS TRACT .� Owner's Name r=-r � _ -------------- ---- --Phone "-----""-----"- Address /W/ s ------------ City ------------ ------------------------------------------ ractor's Name License # _!CZ5_S�Phone ------------------------------ Cont' --------------------•-------- ft Cont Installation will serve: Residence.[?Apartment House❑ Commercial []Trailer Court Mot ❑Othe�---------------------------------- Number of living units:- ----t- Number of bedrooms : _-_-Garbage Grinder ------------ Lot Size ----41---- .-- -----_ Water Supply: Public System and name ----- - -- ----------------- -------------------------------------- ------Private 1 Character of soil to a depth of 3 feet: Sand';e/ Aclobe �Siltfl Clay ❑' .,PeaEl E]t Sandy Loam Clay Loam Hardpan E] Fill Material :_Jf.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 [ ] SEPTIC TANK`[ ] Size,'`_-_:-----_-_--__. :_'_ --_ _ ------- Liquid Depth --------------------------- Capacity p Y -- - Type , Material--------------- No. Compartments Distance to nearest-, Well -.---- -------------------- Pro Line ------------------------ LEACHING - _- --__-LEACHING LINE [ ] No. of Lines ------u _'_ ___.=__} Length of each .line.----.___._--__w-s-:------ Total Length ----------------------------- 'D' -__--_ 'D' Box ------------ Type Filter Material ----------------- Depth Filter Material ---------------------------------------:_--- Distance to "nearest: Well ------------------------ Foundation ------------------------ Property Line -------_.---.--.-_._.._- SE=EPAGE PIT [ ] Depth - ---- ------------- Diameter ----------__"-_ Number ___-______------_"-.---""-. Rock Filled Yes ❑ No Water Table Depth ------------------------------------------i...-Rbck Size --- -------------------------- Distance to Aearest: Well -------- -----------------------------Founclation..._ :__- _ _._.-.Prop. Line ---------------------- 1 REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------------`-------------- Date ----------------------------------_) ASeptic Tank (Specify Requirements) --------------------------------- ---------------------------------------------------------- ------------------------------------------------ Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- ------ �•, �- -y„ ---------------------------------------------- -- -- (Dr exis ing ari required addition.on reverse side)... . h_.,,,.,. ..__ 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..t_he San Joaquin Local Health District. Home owner or licea- , sed.agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued,'l'sl►ail nat'employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -----------------------•------ ------ Owner BY --. �,-a-z 1J, -Q,-A title --------------------------------------------- (If other�than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------------- DATE -- l o ~, - ---------------- BUILDINGPERMIT ISSUED -----------------•-------------------------------------------------------------------- --------------------DATE ---------------•------------------- ------- ADDITIONAL COMMENTS - -------------------------------------------------------------- ' -------------------------------------------------------------------------------------- - --------------- --------- --------------------------------------- ----- - ......... - --- - _ ---- --- - - --- C! - Fina! Inspection bY;,--•---- � - --" ---------•------------------------------------------------------------Date -------` --�- �---- -- - -----•-' SAN JOAQUIN LOCAL HEALTH DISTRICT r r E. H. 9 1-'68 Rev. 5M