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FOR OFFICE USE: F APPLICATION FOR SANITATION PERMIT Permit No:.��'�------- ------------ --- � ---------------,i------------ - -- -- - (Complete in Triplicate) - ! ' -- ----- ------------ ----------- ---- Date Issued "'y7_20 ° This Permit Expires 1 Year From Date Issued r 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. - ] - t f` •_ --CENSUS TRACT S- _"-I --- --- JOBjADDRESS/LOCATION __a�-�r��------ ----� ��'��'"�---- -�� / Owner's Name ---�P/ff-6-14�------..... .� --------------I -------- Phone l lt- - /ff �ef//r'-------�C I11 - ---------------- City �?�G��' Address ---�f�--Q�_.------� -- --- ---- - =- -------- - - Phone ,. �" _ License # f ��. i 6 Contractors Name �-� ----.��`"" --- -- -- installation will serve: Residence Apartment House F1 Commercial [ITrailer Court ;❑ Motel ❑ Other -------------------------------------------- `/ Number of living units:-- ------ Number of bedrooms _ ------Garbage Grinder --/tea- Lot Size 1P2 Water Supply: Public System and name ------------------------- Private_p� Character of soil to a depth of 3 feet: . Sand❑ Slit❑ Clay E] Peat El Sandy Loam Clay Loam ;❑ I Hardpang�;. Adobe.0 Fill Material ------------ If yes,type ____________________________ t (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,) ' it r Size---- S-� �----- --- Liquid Depth --- - -------- PACKAGE TREATMENT ( ] SEPTIC TANK, ----------- �-- (� Material_G /�GNo. Compartments _ ____._k.._____. Capacity P Line Distance __. _ ----•--- Distance to nearest: Well __ ----------------------Foundation _. Q"-------- Prop. f LEACHING LINE bQ No. of'Lines - - -- --------------- _ Length of each fine �Q_p-------- -- Total Length _,9_q0-----•-------- g r fE 'D' Box --- - --------------� Type Filter Material -�-�_�f�-Depth Filter Mater�pi`w--��---- -.-- � s I Distance to nearest: Well ------- -- -- Foundation "-_/_P- Property Line --S-------------------- r e(____ Number __----- Rock 1` ed Yes No :0 SEEPAGE PIT Depth .-- -- --- Diameter .�� -- Water Table :Depth ----�/'C�O-""_-- -_ - Rock Size __.l,�s�" - - ------------------ 1 Distance to nearest: Well ...... --Foundation _ l a,_r�__ Prop. Line __.5__.__'.."___.. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------•-------------"_"-_"" 1 I ------------------------ Septic Tank (Specify Requirements) `------------------- ------------------- " i Disposal Field (Specify Requirements) -------------- -' "------" ----------------------------------- ------------------------------------------------------ ------- -- -- ed addition on reverse si e + {Draw existing and requir 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: "1 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 Workma Com enti la of California." Owner Signed ------------------ { --------- -Title ---------- ---------- - -------------- ---------- - --------------------- (If other than owner) FOR DEPARTMENT USE ONLY DATE:7_`/_ _: --------- APPLICATION ACCEPTED BY . ' Lt - DATE ------------------------- BUILDING PERMIT ISSUED ------------------------ -----------------• -----`---- ADDITIONAL COMMENTS -------------------------------------------------------------------------=--------------------------- € a r: k ------------ ----------- ------------------------------------------------ -/S- %' --------------------------------------------- ------------------ ---------------------- --- --- ---- - -------------------- - --------------------------------------------------- ,�fJ -------•---- -------------------"------ to ------ --- ---- ------ ' Final Inspection by: % --Da - -. -��' - " SAN JOAQUIN LOCAL HEALTH DISTRICT t F E. H. 9 1-'48 Rev. 5M