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FOR OFFICE USE: ., ry APPLICATION FOR SANITATION PERMIT ----- ---- ---------------- ----- -- Permit No. _7/-.3 G�. ' (Complete in Triplicate) •., ---------=--------------------------------------- This Permit Expires i Year From Date Issued Date Issued ._ ` :_ _.7.. 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. 49 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---------------CENSUS TRACT -----------------I--------- m,�-------- © Ic1iF' C------------------------------------ Address Na/`"�dk� -----��1 --------------- _ Cit ------ ----�--------------------Phone --�----------- �- ------------------- ----------------=----- - �s'/" ---`-e t---------- Phone .License # f��_.��_ Contractor's Name _�_�,:9/jLT�r-�--��-�!`7�i� -- � -- -- Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑ Other - -------------------------•---------------- Number of living units ---- Number of bedrooms _>_3------Garbage Grinder ------------ Lot Size ---------------------_______________________ { Water Supply: Public System and name ---------------------------------•--------------------------------------------------------- ------------------Private Character of soil to a depth of 3 feet: Sand'E] Silt 0 Clay ❑ Peat❑ Sandy Loam Rr Clay Loam ❑ • Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ----------_____________--.- {PI'ot 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 ----- .-------...-----Capacity - ---- ------------- Type ------------------- Material----------=----------- .No. Compartments ------•--------_ �r Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -------•--------•------ k LEACHING LINE [ ] No. of Lines ------------ ________ Length of each Lline---------------------------- Total Length ,___-___________-. I-_.;--- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -----------.--------------------------.----- Distance to nearest: Well ------------------------ Foundation ------------------------- Property Line ---------!--------------- SEEPAGE _- _--_._______--:_--- SEEPAGE PIT [ ] Depth --------- --------- Diameter ---------------- Number ____._-_-- ----------------- Rock Filled Yes '❑ No Q ; Water Table Depth ------------------------------------------------Rock Size ------- ------ Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------------------_-- REPAIR ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----.-.---------------------------! Septic Tank (Specify Requirements) ---------------- ------ --------------------------------------- --------------- Disposa�l. Field (Specify Requirements) f � Ti ' � ' -c �dT------- =------------------------------------------------------------------------------------------ -----------------._..------------- . (Draw existing and required addition on reverse side) .)]-,hereby 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 Regu'ations of the San Joaquin Local Health District. dome 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•fit employ any person in such manner as to bec ct to Woo n' o t' n laws of California." Signed -- - - r - -- ---------------------- By ----------- - --- - --- - - ---`--- ---'-- - -- ------------ �- ------- Title --�� -------- ------ ------------------- (If.other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- - ------=------------- ------------------------------ -------------- DATE = - L---------------- BUILDINGPERMIT ISSUED -------------------------------------------------------- -------------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ------------------------------------- --------------------------------------------------- -------------•------------------------------------------------------ ------------------------------------------------------------------------------------------•----------------------------------------- -------------------------------------------------------------------•- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- -----------------•--------------------- p y= ------ Final Ins action b -->. -------------------------- -----------Date _4' � �--------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.