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.� FOR OFFICE USE: 9 , - * °APPLICATION FOR SANITATION PERMIT r� 3 j ?ermit No: (Complete in Triplicate)hr a ---------- ---------------------- ,f� _ - �. "� . `�� Date Issued This Permit Expires 1 Year From Date lssued Application is hereby made to the San Joaquin Local Health District for a per it;to construct and install the work herein < described. This application is made in compliance with County OrdinancerNo�549 and existing Rules and Regulations: V r f -----CENSUS TRACT JOB ADDRESS/LOCATION --- /- _�.--- Owner's Name _ --- -----Phone ---I------ -- Address -`-'`-��t.� i ---------------- C'ty --- gm Contractor's Name __ -------------- ------License # _ 5� �--- - Phone _---------- ;-Z M4� Installation will serve. Residence Apartment House'7 Commercial ❑Trailer Court +Lj Motel ❑ Other---------------------------------------------- Number -----------------------------Number of living units:-------/_ Number of bedrooms __-_ ...Garbage Grind r ------------ Lot SizeI r Water Supply: Public System and name -------------------- - - -�---� - ---�.---- -------------=--w---------------------- Private'❑ Character of soil to a depth of 3 feet: Sand❑ Silt C3 clay E] Peat E] Sandy Loam �❑ Clay Loam ❑ t - �Hardpan ❑ Adobe Fill Material ------------ If yes, type ___________________________ �f i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION: {No septic tank or seepage pit-permitted if public sewer is available within 200 feet,) W i PACKAGE TREATMENT I: ] SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth -------------------------- Capacity ---- ----------- ----------Ca acit _ Type ____________________ Material---------------------- No. Compartments ___----_...._ Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------------------- t LEACHING LINE ( ] No. of Lines ________________________ Length of each line---------------------------- Total Length ------------------ -------- 'D' Box --t-1-------- Type Filter Material --------------------Depth Filter Material ------------------------------•------•----•- Distance to nearest: Well ------------------------ -Foundation ---- ertLine . . -------------------- Propy -------•---------- _ ..- ' SEEPAGE PIT [ ] Depth ----- ---------- ____ Diameter ________________ Number ----------------------------- Rock Filled Yes E] No ❑ - WaterTable Depth ------------------------------------------ -----Rock Size -------------------------------- Distance to nearest: Well --------------------------- ------Foundation -,------------------ Prop. Line -------------- ....... REPAIR/ADDITION(Prev. Sanitation 1 Permit# -------------------------------------------- Date ________________-_----------------) � e Septic Tank {Specify Requirements) - ; - •...L - , ll Dis sal Field (Specify equirements) ___ _ ------ 114 a -P_e-----'� --6-------------- - - ----- / ce r ak ("n' ------------------------------------------------- - - raxisting 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 Count Ordinances, State haws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- Y sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to bee a sa 'ect to W ma Compena io laws of California." Signed ;4 --------- Owner a ---------- Title --- -------------------------------------- --------------- ---------- (If other than owner) I TMENT USE ONLY APPLICATION ACCEPTED BY --- ---1 - - -- ---------------- DATE _-.- .-I_-_ �------------------ - --- - -- -- -- -- ---------------------------------- BUILDING PERMIT ISSUED --------- _ DATE ------------------------------------------- - - ----- -- - ---- - ------- ---- - - -------------------------------- ADDITIONALCOMME - ------------------------------------.------------------------------------------------------------------ / r y ------------ -------- --- -n -- ------ - - --- - ------ ------------- -------------------------------------------------- --------------------------------- --------- --- -- - - - ----------------- ------------------ - - - ---- - `- --- --- --------------------------------------------------------------------------------- -------------------- -� ) --- ---- Final Inspection b - -- ------ - -- Date --- ------------- -- JOAQIJIN LOCAL HEALTH DISTRICT ` I ( E. H. 9 1-'68 Rev. 5M