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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �7 ---- ------------------------• - - Permit No. .l_�--- (Complete in Triplicate) --------------------------------------------------------- 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 f described. This application i rr e(ig complionc'e with County Ordinance No. 549 and existing Rules and Regulations: c r"�� CENSUS TRACT I: JOB ADDRESS/LOCATION _ � �_ -I�-� � *�----- - Owner's Name - .s _ p -- ----- ------------------------------------ -- --Phone ------------ -- --------------._---- Address ---------------- G � ! A-4 -- City --------- --------------------------------- G r Contractor's Name -- I -' --- ----- - = I `'4 4 .License # 19� _ Phone Installation will serve: Resid nce ❑ Apartment House❑ Commercial.[]Trailer Court i❑ Motel ❑ O1her __07?" -, ____ ` �'+` Number of living units:-----I------ Number of bedrooms y___Garbage Grinder ..---------- Lot Size -------------_---.________________________ Water Supply: Public System and name -------------- -----------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt fl Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam,E] Hardpan Adobe,E) Fill Material ------------ If yes, type ---------_----------------- (Plot -------- --- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) p 'seepaMge pit permitted if ublic sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or { / / _ Liquid Depth --- ----.- PACKAGE TREATMENT { ] SEPTIC TANK'[ Size__ __ _�__._�..�-----�--�_ - ------------- { Capacity IAa-O- AA Type 6 Material--- No. Compartments _._Y__-_---____. } Distance to near st: Well ----------5V------------- ____Foundation ------------ Prop. Line _____----__ LEACHING LINE [► No. of lines �___-_�I r--___ _ Length of each line.--.__. -�d_�__----- -- Total Length -LAA------••------- , , r, 'D' Box ------------ Type Filter Material --_5-/2---------Depth Filter Material ------ 4----------------------- -=•- ! r Distance to nearest: Weill --------64--_______ Foundation -------�---_.-_-------_ Property Line ..�__________________ 0r _.__ Rock Filled Yes e No f0 r IM SEEPAGE PIT [ J Depth -------Z.�----- Diameter __ __ _________ Number _.__.------']----___ Water Table Depth �!' - Rock Size --�-�� / / Distance to nearest: Well ______________ _dam_ __ -------------Foundation ___. ------- Prop. Line ----rte___........... REPAIR/ADDITION(Prev. Sanitation Permit r# -----I1_-._._____---------------------------- Date __-_-_______--_________'.-------) \� Septic Tank (Specify Requirements) -------.-----___II__--------------------------------------------------------------- V� Disposal Field (Specify Requirements) ---------I�-----------------------------------------------------------------------------------------------------------•--------------- --------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- ------------------ - ---------------- -- --- -- (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 andRegulations 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, II shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---- --------------------------------------A------------------I�------ �y Owner F/ Title _ " By --- --- --------------------------------------!,� ------------ - ---- -- (If other than owner) FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY - ---------------------------------- ------------------------- DATE ------------------ BUILDINGPERMIT ISSUED ------------------- --------------M--------------------------------------- -------------------------- ----DATE --------------------------------------•---- ADDITIONALCOMMENTS = '� y -------�k =-------------------------------------------------- ----------------------------------------------------- 1 --------------------------------- - = ?� '`�' - :M --------------- - -- - - -�------- - ------------- ------------------------------------------- a =------- Final Inspection by: -------------------------.Date SAN JIOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M