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/ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT fir¢" `Permit No. .� l G� (Complete in Triplicate) -------- ---- --- - ---- J, /o _-___._ __ .___'._l__l./:__��__ • This 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 Rules and Regulations: JOB ADDRESS/LOCATION .'Ss- ------- ---------------------------- -----------------CENSUS TRACT ------------- ----- Owner's Name --1t-1'14------------------------------------------------------------------------- -----------------Phone ------------------------------------ Address -------- mar ----------------- -----------------------------------------------------.--. City ------------------------------------------ Contractor's Name -------S-, --------------------------------------- --------License# -17--7._8---K-3-- Phone --- Installation will serve: Residence p ''Apartment House❑ Commercial ❑Trailer Court f] Motel ❑Other -------------------------------------------- _ Number of living units:------I----- Number of bedrooms __!Z _Garbage Grinder------ Lot Size x _j6,-U - Water Supply: Public System and name ----------------- Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑/ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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,) r. PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size--------------------- -------------.------------ Liquid Depth _______-____-_-___----_- Capacity ---------------- -- Type -------------------- Material------------ --------- No. Compartments -----------------_•--- ti Distance to nearest: Well __________________________________Foundation ---------------------- Prop. Line .__.______._.__.-_---. N LEACHING LINE [ ] No. of Lines -___- ---------------- Length of each line---------------------------- Total Length ------ ................ Y 'D' Box __________ Type Filter Material ___.____________.Depth Filter Material -------------------- --------------------- Distance to nearest: Well _________ ------------ Foundation _______________________ Property Line ________-___-___-.._.... SEEPAGE PIT [ ] Depth _ _____ Diameter --------------- Number ____________________________ Rock Filled Yes '❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ____________________________----__) Septic Tank (Specify Requirements) -------- ---------------4,----------------------------•----------- Disposal Field (Specify Requirements) _Oe--.j9W__----_4e_�i_f_____ ----4----1---�•-�� ---------------------------------------- ---------- ----------------------------•---------------- --------------------------------------------------------------------------- ---------------------- ------------------------------ ---------------------------- ---------- --------------------- ------------------------- ---------- - ----- - - - -------------------------------------------------------------- (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 sub' c o Workman's man's Compensation laws of California." Signed wned -5 ------------------- Owner BY -----..�1_ `- _ --------------------------------------------------- Title ----------------------------------------------------------------------- (If other than FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- -t- ------------------------------------------------------------------------------. 'DATE ------ - f7_a ------------_---- BUILDING PERMIT ISSUED ------------------- --------------------------------------DATE ------------- ----- ---------------------------------------------•- -------------------- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------------------------- ------------------------------------ ------ -F----------------------------------------------------- .--------------------- - _ - - ------- � _ 1 _ --- --- -,-- anal Inspection by: r-`7 Date ----_7_------ - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M