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^ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: - ----------------------------------- ------------------ -- [Complete in Triplicate) Date Issued ------------_------- - --------------------__--------- This Permit Expires 1 Year From Date Issued -�2- Q30 —?O 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: :..r..�l �!d:iiJ • !,4&t4_,J7-)11:4 N-V V uJ 1 - - � �---------P5�-----------------------CENSUS TRACT __.� -------•---- JOB ADDRESS/LOCATION ._ :.__- _. ___ U Phone ) Owner's Nome o�L - 5 �� ----------------- - Address ------------------------------- --1-- -----� ------------------ ------------ City - -� � Contractor's Name ------------- ------.License # ._____-- Phone Installation will serve: Residence 2rA-'partment 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 Sand Loam Cla Loam p ❑ ❑ Y ❑ ❑ Y ❑ Y ❑ d Hardpan ❑ Adobe.t 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) y� PACKAGE TREATMENT { ] SEPTIC TANK,0 Size_._--w� -- _ Liquid Depth -------- ------------ Capacity _190------- Type Aa1a_.l.�- Material_ ------------- No. Compartments __ _-.__- ---- Distance to nearest: Well --------2J ---------------------Foundation ..../.f-.__--______I Prop. Line ---V0_____________ LEACHING LINE [ ] No. of Lines ----- 5-------------- Length of each line----_--�U_------------- Total Length ._ 7- -------------- 'D' Box,:Y*S-.._ Type Filter Material Sp__Nt ......Depth, Filter Material -------- ------------------- ------ r _ . Distance to nearest: Wet[ -----�r---------- Foundation ------ ---------- Property Line ____S__________________ SEEPAGE PIT Depth ____ Diameter ________________ Number --------- ------------------ Rock Filled Yes ❑ No ❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- C REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- ---------- Date -----------------.----------------) Septic Tank (Specify Requirements) ---------------- -----------------------------------------------------------------------------.----------------__------- Disposal -_------- Disposal Field (Specify Requirements) ---------- ------------------------------------------------------------------------------ ------- --------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------ -------------------------------------- ------------------------------------------------------------------------------------------------------- - --- -------- (Draw existing and required addition on reverse side) '\ I hereby certify that 1 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 t, 1 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 Comperpsatf.on laws of California." Signed T 7 ------------------------ -------------- Owner --- ---------- Title ----- ---- ------------------------------------ --------------------- - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------- --------------------------- ----------- = �__ �DA ES__7- ------- BUILDING PERMIT ISSUED ------------- -- - TE --------------- - ' ADDITIONAL COMMENTS '-'--= ' , a - --------- ------------------------------------------------ - - -------------------------------------------------------------------------------------------- --`-'-t! I------- --------- ----------------------------------- ---------------------- ----- FinalInspection by: ------ --------- ----------------------------------------------- ------------------ --- -- - ------------- SAN ----------- Date • = SAN JOAQUIN LOCAL HEALTH ISTRICT G F " 0 1-'AR RPv_ 'SM