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FOR OFFICE USE: APPLICK-TION'FOR SANITATION PERMIT v -------------- ------------ - --------- -------- Permit No: --------------------- This ----73---y - [Complete in Triplicate) - - ---------------------- Application I -_ X This Permit Expires 1 Year From Date 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 .___.__,_ _S2 _ _ L CENSUS TRACT _SFAVOP_--__- IN Owner's Name ....... C _e /------------ ==-------- ---------------- ----Phone Address ----------------- la+ �/ s / l CitY � z � ____--r-------- Contractor's Name --- ---c - -.---- -.License # ---------- ------------- Phone -------------•------ _ --- ----------- Installation will serve: ~_Residence partment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other ----------------------------------- +------ Number of living units_____________ Number of bedrooms -----------.Garbage Grinder .----------- Lot Size -------__-_-__-_____________._____._.... Water Supply: Public System and name --------------------------------•--------------------------------------..----------•---------------------------Private ❑ Character of soil to a depth hof 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ----------------------- N-1 I O (Plot plan, showing size of lot, location of system in elation to wells, buildings, lett. 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------------------$--------------}---�Z------- Liquid Depth .-.------------------_._ - Capacity -------------------- Type -----------------=-- Material- ---------------;= No. Compartments -------------- ....... ` Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -----------------_--- LEACHING --------- ._.--- (� LEACHING LINE [ j Noll of Lines _ ---------------------- Length of each line---------_ ------------- Total Length ____-_---_-_-_.__-.___-_•_. f D' Box ------------ Type Filter Material --------------------Depth. Filter Material --------------------.--------_.-.-.---_--_._ r Distance to nearest: Well _______________________ Foundation --------------------- -- Property Line ------------------------ SEEPAGE PIT [ ] De Mth -------------------- Diameter ___-___________ Number ___-____._______-.___-____ Rock Filled Yes ❑ No Water Table Depth ------------------------------------- Size ------------------------.------- Distance to nearest: Well ---------------------------------------Foundation -------------------- Prop. Line --___-__.-________•--. I REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ------------------..-___--_____-__I Septic Tank (Specify Requirements) ------------------------ ------------------------------------------ ------------------------- Disposal Field! (Specify Requirement ) ---------.1. -_-- -s - ---------�.$_ ------------•.--------- -- s ----------------------------------------------------•----- � '1= �j� --------------------------- ------------ --------------- (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 beco n subject to Workman's C pens tion laws of California." �il Signed LtiD` - - --------------------------- Owner i By -------------------------:------------------------------- -------------------------------------------- -Title ----------------------------------------------------- ------------------ (If other than "Owner) FO DEPA TMENT USE ONLY ! �3 APPLICATION ACCEPTED BY _ - ---- - -- W DATE --- -- -------- r- -- --------------_ _ BUILDING PERMIT ISSUED -'M.---_---..- --------------DATE ------------ ADDITIONALCOMMENTS i� -----=------------------------------------------------------------------------- --------------------------------- ' --------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------------- -------------------- ------------------------ ------------------------------------------------------------------------------------------------------------- -- -- --- --- --- --------------------------------------------------------- ---- ----------------- - --- - iF ► Final Inspection by: ------------------ --------------------------------------Date--------------------------------------Date ---- 7-: SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M