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FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT --------------- ---------------------- ------------------ Permit No .(Complete in Triplicate) This Permit Expires 1 Year From bate Issued Date Issued - =-.-----�.---- - ------- _-_----_ Application is hereby made to the San Joaquin Local Health District for a per 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 .___- ~� ------:----- 1j � ° -----O-CFNSUS TRACT :------------------------- hone Owner's Name ._. - r - Address7 OF city t4 / License# � - Phone �. � . Contractor's Name __ /. + -- �� --- Installation will serve: Residence ❑ Apartment House❑ Commercial Trailer Court ':❑ Motel MOther T:_ _ _ _--------------------.- — Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------ Lot Size ___- -------- Water Supply: Public System and name ----------------------•--------- ----------- -------------------------------------------------------r--------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam$ Clay Loam ❑ Hardpan ❑ Adobe.F1 Fill Material ------------ If yes, type ____--______'______________ s (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 availabletWifhin 200 feet,) X PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size____.'�X- X_�-___._._T____; Liquid Depth -- --------------- ,� Capacity /�_�------- TYpe f2W4- k�-�-F Material----------------------�No. 'C1ompartments •-•-•--• %- A _ 1 J - Distance to nearest: Well ----.' �----------------------Foundation _/0 Prop. Line �-�----•-.-----� a _ rfLf�__ c g `�------•------w LEACHING LINE [ ]` No. of Lines __�---_____________ Length of each line___ _�" �'fYta en th ___ -�__-_ > 'D' Box __l_______ Type Filter Material XAA�D pth Filter Material ----- -------------------- ----------- iij i Distance to nearest: Well -________.__. Foundation -- --,- Property Line _ ____ ___________VN SEEPAGE PIT [ j Depth -----.------ • s ei - ---------- -------- --- Rock'Filled Yes ❑ No ❑ Diameter ------_-_--- um - Rock Size ------------------------------t- Water Table Depth --------------------------------------- E Distance to nearest: Well -------------------------------------!-.Foundation '--------------'-- - Prop. Line -----------.--------- -� REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------: ---- -'- "J ='r,--'-----6- --- ' -- Septic Tank (Specify Requirements) ---------------------------------------------------------------------------- S ` $" Disposal Field (Specify Requirements) ----------------- - - - w ---------------_ --- ------- f----------------------------------- _________________________________`___________________..________-______--__________ � .____ { - �ti.° 1____-_________--_______-.___ i (Draw existing and required addition on r verse side) i 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 subie to Workman's Compensation laws of California." Signed ----------------------- Owner 3 BY ----------------------------------------------------- -- --------------------------------------------- Title'------------ ----------------- ----------•------------ (If other than owner) I FOR JDEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ----------- --------------- - DATE= ' Ill BUILDING PERMIT ISSUED ----------------------- ----------------------------- -- ---------------------=------- ------DATE -- --------------------------------------- = --]-------------------------•---------- ADDITIONAL COMMENTS ='_`"- - -------`_ - ' = -- --------------_-------------- _rw _ -==--=--- Y 1 --------- ------------------------------ -*_:._ �� a �, -:t1 � _l • --------------------------------- ---------------------------------- s ----------------------------- ------------------- - --------------- --------------------------------- - JINL ---------------------------------------------------- --------- ---- --------- ------ ------------- ------- --------- -- -- ----=-� Date � 'r '� _._ Final Inspection by:. ----------- -------------------------- - GSAN lOAQUL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �1