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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- --- ------------- --------- -- � (Complete in Triplicate) Permit No. ----- 1�1 l ------------------- _____ This Permit Expires I Year From Date Issued Date Issued __�-_3--_73 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: JOBS ADDRESS/LOCATION .---�/¢-�-�---71�-- --- - ----- --- ------ ------- --------�7J't------------------CENSUS TRACT ----------------------- . -------------._�._..._.. Owner's Name .-- C- z�- - --- - - Phone --- -------------•------- -: --- ------------- a Address --- --- -��✓ rc '1--------. City / -------------------- ------ / / ;e. = Contractor's Name - -------- -------- - `_�CLicense # Phone , _ _-__ _�. � Installation will serve: Residence [Apartment House-E] 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❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ------------------------------ (Plot ____:_____________ _______(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,) (1 PACKAGE TREATMENT [ I SEPTIC TANK[ ] Size__�_X_!_Q__!___f/__Y�_______ Liquid Depth __________________ Capacity _L200_____ Type1_... Material__ - No. Compartments -_�-----_-------- Distance to nearest: Well -------5 D----------------------Foundation -----J_A------------- Prop. Line ----Z>_____________- LEACHING LINE j ] No. of Lines -----_7;L-------------- Length of each line-------?-_P------------ Total' Length -----f Kl�t------------- 'D' __ _ _'D' Box _ o Type Filter Material -----Depth Filter Material _. -_f__9---_------------_________________ Distance tonearest: Well ------- -------- Foundation - -1-6------------ Property Line ___;1'___-________ SEEPAGE PIT [ ] Depth _,,j----------- Diameter Number Size ___ ---1f Rock Filled Yes;) No i❑ Water Table Depth ------------------------------------------------ j --------- Distance to nearest: Well ________________________________________Foundation ------------------ Prop. Line __________.____.-.__-_ REPAIR/ADDITION(Prev. Sanitation Permit# __------ ___________________________________ Date _____________.____________________) SepticTank (Specify Requirements) --- ---------------------------- -------------------------------------------------------------------------------------------------=---'---- Disposal Field {Specify Requirements) ---------- ----------------------------------------------------------•----------- --------------------------------------------------------- -------------------------------------------------------------------- - ----- - - - - ---------------------------------------------------------- -------- (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 withjii<in•Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home awner ,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.nianner as to become subject to Workma-n's..Cam pensation laws-of California.'!_ — Signed --------------- ----- ---------------------------------------- ------ Owner By ------------ -- - BY / - --------------- ---------------- Title ---- ----------- -------- --- ---- - ---------- (if other than caner) l OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- _ _ --- --------- -- ---- ------------------. DATE ------ BUILDINGPERMIT ISSUED -------------------------------------------- -------------- ------- ---------- ---------------------------DATE ---- -------------------- ---------------- A,ADDITIONAL COMMENTS ------------------------------------------- -------------------- = -------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- ----------------- ------------------------------------------------------------------------------------------------------- ----------------------------------------------- -----------------------------------•---- -------`----------- ------------------------ ------ = ------ Final Inspection b Ins ' P Y- --�----- -L.�-`- _ _ . - - - _ �� .Date -- �- ---��--�J---- ---- ----- SAN ---SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M