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� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT P _ 30 : (Complete in Triplicate) Permit No, -- �-y- _____ --. -------------- i �] Date issued - -----_---- - ------- This Permit Expires 1 Year From 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 wi County Ordinance No. 549 and existing Rules and Regulations: _ � I� JOB ADDRESS/LOC ATIO --- t/-- _-�. --------------CENSUS TRACT --------------•-------- I Owner's Name - ---------------------------------------------- -- -- ---- --Phone ------------------------ ---------- Address ------ -c i:/_4_;Z� -��---- -- -- ------------- --- - ------------ City ,._--- ---- Contractor's Name ---- '.--____.License #12; ``phone ------ Installation will serve: Residence Apartment House[] Commercial :❑Trailer Court ;❑ Motel ❑Other --------------------- ----------- Water Supply: Public System and name ___________________�:_�-- ��-'_'Garbage G inde _ --------_ Lo Size --------------------------------------- Character ----_-_-_ __ - Number of living units:-------- --_ Number of bedrooms .. _r -- -------� -------------------Private ❑- Character of soil to a depth of 3 feet: Sand❑ Silt C!a eat Sand Loam C! yl ❑ ❑ y ❑ ay Loam,E] 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.' p NEW INSTALLATION: (No septic tank or-seepage pit permitted if public sewer is available within 200 feet,} 1`] PACKAGE TREATMENT [ ] SEPTIC TANK [ ] r Size------------------------------------------------ Liquid Depth -----------------_- CapacitY -------------------- Type -------------------- Material---------------------- .No. Compartments -------------- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --------------- ------ LEACHING LINE [ ] No. of Lines ------------------- ---- Length of each line---------------------------- Total Length ------------------- 'D' ----------------`'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: Wel! ----------------------------------------Foundation -------------------- Prop. Line ----------•----------- REPAIR/ADDITION(Prev. Sanitation Perrriit#----_"".- ------------ Date7" } - ---- -----------------------•---------- � Septic Tank (Specify Requirements) ! t I < Disposal Field (Specify Requirements) `Y --- ] - ----------------- - --------------------- ----------------------- ------------------- ------------------ --- 0 I Draw existing a required addition on reverse side} r I hereby certify that I have prepa d 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: , A "I certify that in the pe ante of the work for which this permit is issued, I shall not employ any person in such manner as to become subject W man Compensation la f California." Signed ------------------- - Owner 1 - I BY �----------------------- --_---- - ------- ------ ----- �-" Title ., ... an owner] �'- - '-�------- ..- -(I other than • FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY Cn ---- ----------------------- -----------------------. DATE -�� BUILDING PERMIT ISSUED ------- ----- ---- - -------------------------------------- .- --- -----------DATE ------------ ADDITIONAL COMMENTS --------------------------------- -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ---------------------- •---- -- --------------------------------- r�• ` = ---------------- ------------------ - Final Inspection by: ------x1� ' �RN•�-i,h-- -----------Date ------ I7 -w SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.