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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -- ------------------- ---------------- ----- (Complete in Triplicate) 41 -------, - :� _- . �.-�_____----_ - ----- 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: 33 4-- r5------ a -------- -------------CENyS. US TACT -------------.------------ JOB ADDRESS/LOCATION --- __ --, I ' Owner' -- G/ ------------------------------------ ----------------- --------------- ---Phone ------- s Name -arCity .: Address -------------------- ----------- ; �- ! Contractor's Name ...'------------=------------ ---- -) --.License # ------- -.--------------- Phone ------------------------------ r -if-i; { ----------------------------- Installation will serve: Residen � ceApartment House�❑ Commercial :❑Trailer Court l❑ � f Motel ❑Other----------------------------------------------- Number ----------------- -------------------------Number of living units:-------/---- Number of bedrooms _-_., ----Garbage Grinder --_r/-___ Lot Size _-/!1!! X -I-5- ---------------- Water Supply: Public System and name ------�u f! ---- 5�?^-----�oaF-v.''h 5 �-- rs------------------I---------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt.❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clad•Loam � Hardpan ❑ Adobe ❑ Fill Material ___________ If yes, type ____________________________ (Plot plan, showing size of lot, I ca, ii of system in relation to wells, buildings, etc. must be placed on reverse side.) W f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) C7 F PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size----------------------------------------- --- - Liquid Depth _--------------- ---------- Capacity --------y------ TYPe ---------------------Material.-------- ------------ No. Compartments --------------- ------- Distance to nearest: Well ------------------------------ -----Foundation ----------:---------- Prop. Line ----------------.----- o _. ... . i LEACHING LINE f ] No. of Lines ------------- N ,Length bf,each liinne---------------------------- Total Length ___------------ 'D' Box ---__ ------ Type Filter-Material �"_-_--Depth-Filter-"Material -------------------------------------------- i Yp - Distance to nearest: Well ----- '-----------/Foundation ---- --------- Property Line, -_____________________ s SEEPAGE PIT J-1 Depth ____________________ Diameter: --------.___.,_yNumber --------------------.------- Rock Filled Yes ❑ No i❑ {� i Water Table Depth = _--- - ==-----Rock Size ------ ------------- - Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------_---------- REPAIR/ADDITION(Priv. Sariitation Permit# -------- --IS-�---------------- Date ----------) IL i Septic Tank (Specify Requirements) -------- -------- --- ---------------------- -------------------------------------------- ,.. -------------- Disposal Field (Specify Requirements) �----------rl!'-_T'ou7e------_--- E _ -------�i'tir------^t_t^Qt"'---_----= 0 ------------ Ia4------- -Q----------Is e1v�� _ -------------------------------------------------- - ---------------------------------------------------------------------------------------------- (Draw.existing and required_ad dition on reverse.side). f 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 --------------- Owner U y kBy ----------- - �ill�i .Y ----------------- ------------------------- Title ----------------=- -- ---- -------------------------------------------- (if other than owner) FO EPAR ENT USE ONLY �j APPLICATION ACCEPTED BY --------- - r� ---ll----- - - ------ ------------------ ----------------- ------------------- DATE --- ---- -------411---- --r---- BUILDING PERMIT ISSUED -- -- =- = _n -----------DATE-.--,---- ADDITIONALCOMMENTS ------------ ----------------------------------------- ------------------------------ ------- ----------------------- --- ---------------------------------- i i ------------------------------------------------------------------------- -------------------------------- ------------.,----------------------- -------------------------------------------- ---- -- --------------------------- ---------------------- ---- ---------- ------- Final Inspection by Date ----------------- ----------- ------ SAN JO QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M