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FOR OFFICE USE: .- APPLICATION FOR SANITATION PERMIT ----------- -- '(Complete in Triplicate) Permit No. . -------------------- T 3 Thi �! /7 ------------------------------------------------- s 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 Mules and Regulations. c JOS ADDRESS/LOCATION .3.- s -------------------C /--- ------- ----- .CENSUS TRACT ----- Owner's Name M-/iley-Z ------ ------- ----- Phone Address Cit .� City 114s f/Yl�_e ifL Contractor's Name ------------- -------License �- _ -- �� -------- -------------------------- --- Phone --- ---------•----...--. -- Installation will serve: Residence ®Apartment House❑ Commercial ❑Trailer Court ;� [ Motel ❑ Other ------------------------------•------ •-- Number of living units:-.------- Number of bedrooms __2------Garbage Grinder --___----. - Lot Size _/ �__�_ Water Supply: Public System and risme __---__-- _ pp y ------------------------------------------------ Private ❑ Character of soil to a depth of 3 feet: Sand'[ Silt❑ Clay C] Peat❑ Sandy Loam .C] Clay Loam .C] 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.) NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK, [ size Liquid .Depth -------------•------------ Capacity -- ---------------- Type -------- ---------- Material----------- ---------- No. Compartments UU Distance to nearest: Well ------ ------_Fou ation -----.----------------- Prop. Line ----------•--,---___-- ------------------ -- LEACHING LINE [ j No. of Lines -------=---------------- ngth of each line--- ------------____-- Total Length LA ------------ ------- I D' Bax ___- Type Filter aterial ------------------- epth Filter Material ------------- ' Distance to nearest: Well '/Foun tion----- = Property Line------------------------ EEPAGE PIT ber --------------_-_-------_- Rock Filled YesC ] Depth ------ ------------- Di eterWater Table Depth --.Rock SizeDistance to nearest: el! ---------------- -- ___Foundation _-_-----------_--- Prop. Line ._------___-_._- REPAIR/ADDITION(Prev. Sanitation Permit# -_-----__---_ __________ __ pate Septic Tank (Specify Requirements) ----------------------- -- Disposal Field (Specify Requirements) ----- - -- - n ------------------ s ---------- = ----------- �--------------------- 1��- �3--------------------------------------=------------- ----------- ------------------------ - - --------------------------------------------- - ------------------------------------------------------------------- raw 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 Rain- sed agents signature certifies the following:. "I certify that in the performance ofthe work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Cpm ensation laws of California." Signed --- ---- -- — i Owner SY Title -owner) n --------------------- - -------------------- other than owner) -=------ -------- ------- FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED 8--- -------- -------�--- ---------------------------------------------. DATE -------- -- ------- BUILDING PERMIT ISSUED --------------------------------------------------------------------I ---- i -------------------- ADDITIONAL COMMENTS ----- ---------'- ----------- - -------DATE ----- ------------------------------------- ------------- ------- --------- ----------------- ------------------------- k --------------------------- ----- ---------------- ---------------------------------------------------------------------------------- - -- -------------------- ------------------------------------------------------------------------------------------------------------------ Final Inspection b p y- ---- -- --- ------------------------ e ----------Date --------------------�--------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT �. E. H. 9 1-'68 Rev. 5M