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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT s �/-- ------------------------ ------------------ ----- {Complete in Triplicate) Permit No: -- ----------------- This Permit Expires 1 Year From Dale 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/LOCATION _-.'�-C3_ '. -°�'1'�' �� CENSUS TRACT I -------------------•-------- ' e Owner's Name ------ Phone --____-- ------ -- -- - ------ - - Address -------------- !_ r b City - -- -------------------------------------------------- Contractor's Name --------- ` --- --- --- ------ --•License # __ _ Phone -- 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'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam.E] 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 reverse side.) IU p seepage pit permitted if public sewer is available within 200 feet,) r I NEW INSTALLATION: (No septic tank or !` SEPTIC TANK'[Je _ .�x ------- Liquid Depth --------------- PACKAGE TREATMENT [ I Size ---- --_-- qy Ca aciType - Material - No. Compartments -aZ_____________*-- - ------ 0 1 ' Distance to nearest: Well ---------- -------------------Foundation -------19----- - -- Prop. Line LEACHING LINE [� No. of Lines ______ - ------ Length of each line______ -AU- ----------- Total Length _--�_7v__________-...__ 'D' Box ----I----- Type Filter Material. ----- --- ------Depth Filter Material ----f --------------------�------- i a-------------- Property Line. Distance to nearest: Well _______��p-�.-+_ Foundation _.__ __ ---�-----------•=•--- Rk SEEPAGE PIT [1� Depth I------;47-1___ Diameter _--3.3__ ___ Number -------- Rock Filled Yes .[g No [3-------------------- Water Table Depth --------------?P-----------------------------Rock Size ---- ------------ , V II rC ' - --�____-- Prop. Line _____ Distance to nearest: Well --------- - __-____t-_-______-._Foundation ____..__ ______________ ► REPAIR/ADDITION(Prev. Sanitation Permit # -------- ----------------------------------- ------------ Date ______ _________-_.-------_-__-- I - Se tic Tank (Specify Requirements) _ ---- ------------------------------------------------------------------------------ -----------.-.,---------------------------- I DisposalField (Specify Requirements) ------------------------ ---------------------------------------------- ----------------------------------------------------------- .I. ---------------------------------------------------------------- -------------------------------- -------------------------------------------------------------- -------------------------------------------------- -- ------------------------- ---------------------------=--------------------------------------------------------------------------------------------- (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 licen sed agents signature certifies the following: "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." r . ISigned ---------------- ----------------------I --- --------- -------- Owner �:---------------------------------------- BY ------ --------------- ° Title E ----------------------------=----------- ---------------- (If other than owner) FOR -DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . - - ------------------------------------------------ DATE ----- -------------•----- BUILDING PERMIT ISSUED ----------------------- ------------------------.------------------------------------DATE ------ ADDITIONAL COMMENTS --!�1--(-7C-----4-AK-S© r-------'-V" -Aq------------------- ---------------------------------------------- ------------ ------------------------------------- ------ ----- ---------------------------------------------------------------------=----------------------------------- ----------------------------------------------------------------- - t --------------------------- ----- --------------- ---------------------- --------- --- ------------ - ---------------------------------------- ----- -------------- -------- 1 - FinalInspection b --- ---- ----------------- - ------------------------------- --------------------- - -._Date --- �� ---------- ISAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M.