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FORiOFFICE LhSE: APPLICATION FOR SANITATION PERMIT r75- '� 0- Permit No: (Complete in Triplicate) This Permit Expires ] Year From bate Issued Date Issued _7-5--4i Application is hereby mpcle.to the San Joaquin Local Health District for a permit to construct and install the work herein described. This`application is mode in compliance with County Ordinance No. 549 a existing Rules and Regulations: c JOB ADDRESS/LOCATION r --}----- . -- CENSUS TRACT ="==, = ".."." Owner's Name - ,} .. - - - --- ---- --- - -----il��:.c----�---=---------- ----------------- .-- --------- Phone ..................-•--- -------•---- Address � � r -------------------- City --------------------------- ----- -- �� _------_.License #G4I� C�••�• � 1/ Contractor's Name _ ______ _ __ ___ ____ _____ -- -�--_ Phone Installation will serve: Residence partment'House^❑ Commercial[ITrailer Court U] / Motel ❑Other - -�n-----=---------•----•--------------- Number of living units;---- Number of bedrooms __ '.Garbage Grinder Lot Size-------------------- Water Supply: Public System and name :� ''•-------:I------- - Private Character of soil to a depth of 3 feet: Sand'(] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ED 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.) I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTICTANK Siz1 . _9f- ------------- ------ Liquid Depth -_ ------------ 1z _-_----- Capacity gDD-_--_ -- Typefxe_ Material__-[.:.�- ----- No. Compartments ---------------------` �V Distance to nearest: Well --- ------------------------Foundation ... ----1 ------ Prop. Line -_- I LEACHING LINE ] No. of Lines---/------------ Length of each line------ -Q- ---.--- -- Total Length -- r D`-------------- • 'D' Box -------- Type Filter Material l �/ _Depth Filter Material _--- -------------- -------. Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ----------- ...... � T { SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number --------------------- _----- Rock Filled Yes ❑t. No 0 Water Table Depth ------------------------------------------------Rock Size ------------------------_ Distance to nearest: Well --------------------------------------.-Foundation _.---------_------- Prop. Line ---------------------- REPAIR/ADDITION(Prey-Sanitation Permit# ------ ----------------------------- Date --------------- ------------------ ! Septic Tank (Specify Requirements) ----------------- 171— = '...n--- - , . r Disposal Field (Specify Requirements] - . --------------------------------`" --------------------------------------------------------------------- ° r------------- 1. F e f {Draw existing and required addition on reverse side) i 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 tho"t in the performance of the work for which this permit is issued, I shall not employ any person in such manner i as to become subject to Workman's Compensation laws of alifornia." Sig ------ ---- - --- --- --- ner BY itle (If other than owner) "'. a FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED i3Y r- -------------- DATE ---Py$7z76�----------------- BUILDING PERMIT' ISSUED --- ------------' s--------------------------------- --------------------- --------------- --------------DATE ------------- ------ ADDITIONAL COMMENTS ------- -------------- ------------------------------------------------ -------------------------------------------------------------------------------- ------ -- - ---------------------------- ------------------------------------------------------------------------------------------------- Final Inspection by: �` -- ---------------------------------------------------------------------------------------------Date ---- ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9' 1-'68 Rev. 5M I