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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- ------------- -- -� �-. Permit No. . '7/-- -- , ------ e— (Complete in Triplicate) This Permit Expires 1 Year From Date Issued a ' Date Issued -S--t 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 incompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -. YY,12 ;s tir " CENSUS TRACT - Owner's Name -� ----------------- �T '"-)---- ---------------------- --------Phone ------ ----------------------------- ' ' �� y --------------------------------------------------------- Address --------------------- //-��-��j�j - �- - a-��------- �------. city "/ Contractor's NarnJU- __ -c` r l '- -�7'+�� vt� .J.--- License # 1&23-��-T--.-- P h a n eO 3,f_�_(/-.._.--_ Installation will serve: Residence Apartment House-[I Commercial ❑Trailer Court 0 Motel ❑Other ------------------------------------------ r � Number of living units:--- Number of bedrooms -�------Garbage Grinder --------- -- Lot Size /O_4----- ---------- Water Supply: Public System and name - ------------------------------------------------------------------------------------ ------------------------Privatev Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobeV Fill Material _- ---_ If yes, type ---- ---------------- 0'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-----------------------------------..._4----.-_ Liquid Depth --------__------_----.--.-- Capacity -------------- Type -------------------- Material---------------------- No. Compartments ------•--------------- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ------_-_--_---_-._-_- LEACHING LINE [ ] No. of Lines -------- --------------- Length of each line------- ------------------_ Total Length --__--_----.----------__- 'D' Box ------------ Type Filter Material -----5---------------Depth Filter Material -------------------------------------.------ Distance to nearest: Well ---------------------- Foundation ------------------------ Property Line ___-_----_-------.___-- SEEPAGE PIT [ ] Depth - Diameter --------------- [] C - Number -------------__-__-------- Rock Filled Yes No Water Table Depth ------- ----------------------------------------Rock Size -------------------------------- i Distance to nearest: Well --.--.-- -------------------------Foundation -------------- ---- Prop. Line ------------------_-- REPAIR/ADDITION(Prev. Sanitation Permit,# -------------------------------------------- Date -------- ------------------------- L t Septic Tank (Specify Requirements) ------ - ----------------------- - - , ------- - -- -------- --- --- ------------ Disposal Field (Specify Requirements) ---------------------------- �,,�x------` x ---------- ------------------ -------------- --------------- -r�- - -�. -�_ -.� -------------------------------------------------------- ----------------------------------------- - - -------------------------- - - ------------------------------------------------------=--- ----------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this applicationland-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: s "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 VVorkman's Compensation laws of California." g ------------ 5i ned _ "`/ r-1. Z�.cr4`e- � r 9 By __ . Title ---- ------------------------------------------------------- ---------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -_ _ --- - - ----- DATE --.. _-r�4.� - --------------------------------------------------------------- ---------------- BUILDING PERMIT ISSUED -------- ------------------------------------------------ ------------------------------- - -- -------DATE ------- ----- - - ADDITIONAL COMMENTS .- --------------------------------------------------------------------- --------------------------------------------------- ----------------------- '----------------------------------------------------------------------------------------------------------- ------ ---- - Final Inspection by: -- -- --= Date ------( " -- ----- - --------- i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M