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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No, -7_-2_-:_2,5_J -------------------------------------------------------- - __---------------------------.------------------------- This Permit Expires 1 Year From Date Issued Date Issued _Y= L 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: JOB pDQRESS)LOCATICN ---- I--"-----e,- �� ----- - __.---CENSUS" TRACT fp------_----•-------_-- -- Owner's Name ------1�c ------ , -------•----------------------------- -------Phone A`� � Address ----- ' L l - =P'fL�®--------- - -----------------I_ City ----- ` l.+7� Contractor's Name --- License # -- �?D_1 � Phone 3=1LS�- Installation will serve: Residence Apartment House❑..Commercial [-]Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:...(------ Number of bedrooms ___-...Garbage Grinder . -_ Lot Size Water Supply: Public System and name ----------------------•-----------._.------------------------------------------------------- •---------------Private,' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan tZ 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.) (,nl NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE= TREATMENT { ] SEPTIC TANK.( ] Size--------------------------------_. -------------- Liquid Depth ----------------------- 6\ Capacity -------------------- Type -------------------- Material------ ---- ------ No. Compartments ------------------•--- Distance to nearest: Well ------------------------------------Foundation ------------------ Prop. Line ------ ------------- LEACHING LINE No. of Lines --------/------------ Length of each line------- 4_0-.---_--- Total Length -------- 'f~-eQ--------- 'D' Box ----1----- Type Filter Material -------:% Filter Material ------- _�----------------------- Distance to nearest: Well _---_ .._dFoundation / _ Pro er Line, �0/ ----__ p tY ---- ---------- SEEPAGE PIT ;� Depth � (Diameter /-_--_--.-_� Rock Filled Yes No 0 p ---- t Number Water Table Depth -------------� -- Rock Size _----.�---------------------- Distance to nearest: Well ------ QQ__________________Foundation __ f�� Prop. Line _f REPAIR,/ADDITION(Prev. Sanitation hermit# ------------------------------------ -------- Date ----------------------------------) Septic Tank (Specify _Requirements) _____________________,,_(_ Disposal Field (Specify Requirements) ---------------- _ ._ - ----/ - ------_--- -------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition 6n 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 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, t shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------- ----------- ---------- Owner BY ----: Title - `- (If other than owner) FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY .. ------------------------------- DATE _3'I�I - ] - ------------------- BUIL DI"NIG PERMIT ISSUED,_ - - -- -- : ------------- --- - -------- --DATE - -------------------------- -------- ADDITIONALCOMMENTS =----------------- ------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------- ----- --------- --------------------- Final Inspection b ` 1 P Y Date ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M L, --