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FOR OFFICE USE: �A-PPLICATION FOR SANITATION PERMIT - -- -- ---------------------------------------• v �- Permit (Complete in-7riplicate) ------------ ------------------------------ ----------- _________ This Permit Expires T Year From Date Issued Data 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 m i� Cfmpliance with County Ordinance No. 549 and ex'sti Rules and Regulations: , JOB ADDRESS/LOCA 710N ._ __ . �f' . � �J�1.el_ -.- — NSUS TRACT "€ Owner's Name .-- - - � I --- -- --- ----------- --------------Phone ----- - ---------------- Address Cit ________ 11 e �Wl --------------------License /i Phone��O_-_ ZZ Contractor's Name ___ Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court '0r' Motel ❑ Other ________________3-------------------------- Number __Number of living units:_.____ Number of bedrooms ------Garbage Grinder Pkv_ Lot Size -____ Water Supply. Public System and name ________________________ I ___________Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam 0 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 ieverse side.) i NEW INSTALLATION: (No,septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] ` SEPTIC TANKSize_ _ Liquid Depth Capacity Type v Material s '___ No. Compartments _________________- Distance to nearest: Wel __ ____-_ __ f �� ----------Foundation d ---------------- Prop. Line . LEACHING LINE No. of Lines ----�-------- Length of each line._1149W�__.______ Total iLerigth , �___________ D' ,Bo __ Type FilteiMaterial -.____ .Depth Filter Material �_______._____________________ Dista tto_nearest:.Well__, _-_______. Foundation` sI___-01 -_-_ Property`Line .... .. ...... .. . SEEPAGE Piz Depth -_ Diameter ,.?&------- Number ---��_ _ Rock Filled Yes," No C, -------------- Water Table Depth„------ -----`- -------------------------Rock Size/a€--- •------ + �M 4 y ` le f Distance to nearest:LWell ___� _ _;__________________Foundation __��______ Prof.9Line _._ ------------- REPAIR/ADDITION ____-___ . REPAIR/ADDITION{Prev. Sanitation Permit# ______________ ---------------- -_-Date ---.__-___________________________) } Septic Tank (Specify Requirements) ---------------------- --------------------- -------------------------------------------------- --•.-------------•--------------- Disposal Field (Specify Requirements) ------------------------ '.------------------------------------------------- -------------------------------------------------------- ------------------------------------------------------------------------------ ..._ I hereby cern that I have re ared this-application___ ganand that th-_ - - (Draw existing and required addition on reverse side) y fy p pa 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: P. ) "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 x k �= BY 7�--_-�------------------------- Title E`� t; ilf r than owner) e e 4 c FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ____ _ ._ - ' ------------------ ---=--------------------------------------------------------------• DATE �--�'�.��------------------ BUILDING PERMIT ISSUED --- ` ---------------------------DATE -------------.----------------------------. ADDITIONALCOMMENTS ------------------------------------•-:------------- ---------------------------------------------------------------------------- ------------------------ - -------- ------------------------ --- ---------- -- - ------------------------------' -------- '--- ------------------------------------------------- --- --- - - -------------------- ------ ---- ------- --- ------------------- ---- 4 -- Final Inspection by: d V 71-- -- i ------------------------------------Date.!--- r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M l