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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Z . 3 - ------------- -- -----•-'----- ----------------------- ,. Permit No. - ---------------- (Complete in Triplicate) ----------1- ------- Date Issued ------------ This This Permit Expires 1 Year From Dale 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 madejin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC TION ._- � � -? - --U }�� I{ 1� CENSUS TRACT --------------------- -Owner's Name - v41 ------ �- -` ------------------------------------------ __Phone �. --------------- ------- -------•-------------- Address -- c5.A5- L /71- ------- ------�-- ----------------------- City y ��• �� - License # � 3 Phone Contractor's Name ___ t +� � Installation will serve: Residence TApartment House-E] Commercial :❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:.___? ----- Number of bedrooms -_-F-----Garbage Grinder ------------ Lot Size - K]!---------- - - -- ------- ----- Water Supply: Public System and name ---=------------------------------ii - - --------------------=--•--- ------ Private NCharacter of soil to a depth of 3 feet:._ Sand'[ Silt❑ Clay ❑ . Peat ❑ Sandy Loam El Clay Loom ' E , 'Hardpan ❑ Adobe'❑ Fill Material --------- if yes, type ---------------------------- {Plot plan, showing size of lot, location of system in relation,.towells, buildings, etc, must be placed on reverse side.] NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is availcible within 20d feet,) � r PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] �.. Sife---------------------------- ------------------- Liquid Depth -------------------------- + T e _,Material------- ------------- No. Compartments -----•----------•----• 6\ Capacity ---------------- yp , --- to nearest: Well: ---- ----------------.,------------Fou dation ---------------------- Prop. Line --------------- Distance --•---- I LEACHING LINE [ ] No. of Lines __ _____________:-1----{ ength of each line._-- Total Length 'D' Box --------- -- Type Filter aterial -------------------- - pth Filter Material --------------------•----------------------- # Distance to nearest: Well Property Line ________________________ F ------------ oundat' n ' SEEPAGE PIT [ } Depth - ___-_-- Dia ter ______________ Numb r ___-.__ \------------------- Rock Filled Yes ❑ No i❑ Water Table Depth -------- ------------------------------------ --Rock Size`'- ----------------------------- Distance tol nearest: Well ----_ F undation -------------------- Prop. Line _.---_____ II ----------- REPAIR/ADDITION(Prev. Sanitation Permit# ---- ------------------------------------ at --------------------------•-------1 -------------------------., -------------------------- -4 Tank (Specify Requirements) -----------------------------"-- -4 --------------------------------------------------- Dispos I Field (Specify Requirements) ------ ----------- ----- F �" !_ .v ------------� ------ � �� d 6 /-f-------- -� _ a ;.�!i -.-- . -------------------------------------------------------- a - 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, aid 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 F as to become sulyect to Wor an's Compensation laws of California." i Signed --- --- ----- ` - ---------------------------- Owner ----------------------------------------- By ----- --- --------------------- Title -Efother than owner}' L FOR DEPARTMENT USE ONLY J J APPLICATION ACCEPTED BY ---.� tl��' ------------------- ------------------- ------ ----- DATE - l-`-�Q__�. .7 -' BUILDING PERMIT ISSUED -------- tt---- -------DATE ---------------------------------------- ADDITIONAL COMMENTS } 1--------------------------- --- ---- ---------- - - -- t t Date ------ - ----------------=- -- ---------------- ----- --- ------------------------ - - Final inspecti c --------------- ------ 4 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M