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4 FOR OFFICE USE: _ 'APPLICATION FOR SANITATION PERMIT � - ------- - ---------- Permit No (Complete in Triplicate} �y � Date Issued 1,;2-`r�'-- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describ d. Thi application is Tadle in com liance with County Ordinance No 549 and existin Ru_les�and ulations: JOB AQQRE LOC ION .-' - ------ ---- f ------------------------t �----------CENSUS TRACT - Owner's Name _ �j P - ---- - - - - ---- -------------------------------- ------- ----------- Address ------------ ------ -- --- ---- 1-<-4i___-r City -- - ----------- ` Contractor's Name - -- ______.License #/- ��---------- Phone W -��°�--- --- --------------=- - - ----- ----- ------------------------------ Installation will serve: Residence ❑ Apartment House Commercial [:]TrailerCourt ❑ # I Motel ❑Other -------------------------------------------- s Number of livingunits------------- Number of bedrooms ------------Garbage Grinder __._____--_ Lot Size ----________-_--_____- --------------------- - Water Supply: Public System and name ------------------------- ------------------------------------ -------•-----Private --------------------------------- - Character-of soil to a-depth-of-3-feet.—Sand'D,� Silt❑Clay ❑_w„Peat,❑ Sanely Loam []- CIaY Loam , 9 Hardpan E] Adobe ❑ Fill Material ------------ If yes,type ---------------�------ (Plot plan, showing size of lot, location of system in 'relation foTwells, buildings, etc. must be placed on reverse side,) Q NEW INSTALLATION: {No septic tank or seepage pit permitted if p@ic�seweps available within 200 4eetJ ............... � ) SEPTIC TANK' --------------------- Liquid Depth !__-•----•---.----- PACKAGE TREATMENT I ] �_ / YPe Material No. Compartments --------------------;. Capacity i Distance to nearest: Well ----t----------- Foundati __,�-f>__-___------ Prop. Line ---- ------- -- LEACWING-L.INE -- No._of_l Ines , _ '____.._____ Length of each line____1-00-___-___.___- Total Length ••---• " .... D' Box -----------_ Type Filter Mate _ ==---=Depth Filter Material _._ --------- ---------------_---- Distance to nearest. Well _/40,_�' Fo--.�. � ion -----�-�- undhf a 0, _ '� � _`4� ---------- Property Line. -- ------------•----- I �. K s SEEPAGE PIT [ ] Depthyiam ;_.'- ---- Deter 1 -�:_-�Number "------------,-- Rock Filled Yes C:1 No Water Table Depth ---_'_ �..=-__--- — ---t . Size -------------------------------- ; '�� Dista cn a to nearest: Well ----------------------------------------Foundation - ---- Prop. Line ----------- ------ REPAIR/ADDITION(P`v. Sanitation Permit# -------------------------------------------- Date ----------------------------------) ' --------------------------------- Septicc -Tank (Specify Requirements) ------------ -- ----------------- -----'---------- ------ - Disposal Field (Specify Requirements) ------------ ----------------------- ---------------- -- ------ ------------ ------------ k ----------• -- ------------------_---------------------------------=-----------------------------------------------------------------------------"-------------- --------------------------- --------------`----------- (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 liven- 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 E as to become subject to Workman's Compensation laws of California." i Signed ------------------- ------- --- ------ ----------------- Owner Title -- ------------- (If other owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE _-.� _� �� --------------- BUILDING PERMIT ISSUED ---------------------- --=-------- DATE ADDITIONALCOMMENTS =------ -------------------------------------------------------•-------------------------------------------------------------------=--------------------------- ------------- ----------------------------------------------- --------------------- ------------------------------- ------- / 4 ' Final Inspection b Date -------_-`-----G -------- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M .-.