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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 �� --------------- -------------------------------- (Complete in Triplicate) Permit No. =- --------- ---------------------------------------------- - _______________________________________________________ This Permit Expires 1 Year From Date Issued Date Issued �--- �F/ �3 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 compliances with/County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ate...... L'" C CENSUS �4CT � �---- Owner's Name -/�-1�------ 1 _ � -� ---------------=--- -----------------Pho e - .------------------------------- Address C�- ----- s� � l�U 9---9--- -- ----------. City /7l0/✓ ----------- ----------------------------------------- Contractor's Name .__. �� .__ / /` ---------------------------------- --- Installation # _ ._ ___ ___ - Phone �-- _ Y "G � i Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- l g I-___-__Garbo a Grinder ----_---__ - Lot Size � �' Number of living units:____-r__- Number of bedrooms g '________________________________ Water Supply: Public System and name -------------------------------•-•----------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand 5§ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam '[] Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ____________________________ (Piot pian, 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 ____________________ M' eria(---------------- No. Compartments W Distance to nearest: Well ---------------------- ------------Found ion ---------------------- Prop. Line ----------....... .---- LEACHING LINE [ ] No. of Lines ------------- Length o each line_____ ---------------------- Total Length ---------------------------- 1f".. 'D' Box - Type Filter Materi ___________________ epth Filter Material --------------------.-------................ Distance to nearest. Well __________ ____________ Foun tion ------------------------ Property Line ______________--________ SEEPAGE PIT [ ] Depth ---------- Diamete ______ ________ N be. .... --------------------- Rock Filled Yes ❑ No 0 Water Table Depth --------- -- ------------------- ------ --- ock Size ------------------------ ------- Distance to nearest: Well _______________________ ____________Foundation ------------.-_..... Prop. Line ____-.__-_.-__----__. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------} SepticTank (Specify Requirements) ------- ------------ ------------------------------------------------------------ ---------------------- ------------------ ------- Disposal Field (Specify Requirements) ------!_ CLQ_------ ------ � _------ ---f�-. ------ --------- rr -----------�----------- �'�5 -t1fV1----- ------ ----- --------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 become subject to Workman's Compensation laws of California." Signed __W( o NOwner BY ----- -- " - - ------------------------------------Title ---------------------------------------------------- - r than owner FOR DEPARTMENT USE ONLY 7 APPLICATION ACCEPTED BY l `Q - ---------------------- DATE - 1�= BUILDING PERMIT ISSUED ------ ------------------------------------------------------------------------------ -- - - - ---DATE -- -----------------------------ADDITIONAL COMMENTS ------ ---------------------I------------------------- -------------------------------------- - ------------ ---------------------- - ----------- ---- -- - ---------------- ---------------------------------------------- --{--l-------------------------- -- -------- —! - ------------------------ ------------ --- Final Inspec i -----Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M t.