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*-FOR fnFFICE USE: 30. APPLICATION FOR SANITATION PERMIT /(-�'�'"� �---�=•_'--------- -` Permit No. 6 (Complete in Triplicate) _ = 1 -tel-tr` ----------- --------------------------------------------- This Permit Expires ! 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 � C�ou ty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA ON (.� ��.41-�, ---�-- ------------ CENSUS TRACT -----/�` ----------- Owner's Name --- � '^�r .-------Phone �jL ------ Address ---- ------------------ ------------------- -------------------•--- City ----------------------------------------------------------------•--.......-- Contractor's Name --------------(7 F --- - -----*-- -f' a--- ------.License # -�1�----- Phone -- Installation will serve: Residence ❑ Apartment House❑ Commercial Trailer Court rr Motel ❑ Other ------------------------------------------ Number --- ----------------------Number of living units------------- Number of bedrooms ___________Garbage Grinder -__ Lot Size _+_ /.S----------------------- - c f Water Supply: Public System and name _ " 1- __�_K___ ---f-----------------------------s._ Private ❑ Character of soil to a depth of 3 feet: Sand'o Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loa,'❑ Hardpan ❑ Adobe�( Fill Material ------------ If yes, type ____________________________ (Plot plan, showing size of lot, location ofTsystem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank-or'seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ['] Size--------------------------------------------tj -- Liquid Depth------------------ ------ }� Capacity -- ---------------- Type,-�� ''�-------.Material---------------------I No. Compartments --------- ••------• eQ Distance to nearest: Well __ ._____ _________Foundation 1_____________________ Prop. Line ---------------------- LEACHING LINE No. of Lines'_ ._ ___.__ Length of each,line------------------- __ _____ Total Length D' Box —A------------ Type,F�ilter Material --------------------DeptKi ,Filter Material -------------------- f , Distance to nearest: Well ____._________________ Foundation• _ -____-_________ Property Line ________________________ SEEPAGE PIT ] Depth _______t__________ Diameter ________________ Number _-____:__ __________________ Rock Filled Yes 0 No C Water Table Depth ----------------------------------------•- ------RockV'Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation4ermit# --------------------------------------- Date __.._____________________________) L .� � Septic Tank (Specify Requiremefits) -t ------------ ----------- ---- -------, ------------------------ Disposal Field (Sp ify squire en#s) e _ ____ a s --- - .. =--- . . f f - f ,--- -- ---At r--- - - --- -- - ----- -- - a ,• -----� - - f - - - -------- y_'r_r--rlo_ � , - ; i ` (Draw existing and required addition on,reverse side) I hereby certify that I have preparedythis-appliq ion�,,ttand that the work will in accordance with San Joaquin County Ordinances, State Laws, and Rules and'iReguirations of the San Joaquin 'Local[Health District. Home owner or licen- sed agents signature certifies the following: k ` "'I certify that in the performance of the work for which this permit is issued, I shall hot employ any person in such manner as to become subject to Workman's Compensation laws of California.'_' r� 1' Signed ----------- -- I--------------------------------------�-------------------------=`=•.Ownef�t BY an------ ---------- ----------------- '-==----------------- Title-------- ---- ---- --- -------- ----------------------- (If other thowner) A,4 ^2 1 I F EPAittMENT USE ONLY # APPLICATION ACCEPTED BY - ----- .._ 4____ _._. DATE ___ 9-_ _____________ BUILDING PERMIT ISSUED ------- -- _a-------------------------------- -------------- - -------DATE -- ---------------------------------------- ------ ---------- - -------------------------- ADDITIONALCOMMENTS ------ -----------------------------------------------------------------------------------------=--------------------------- ------ --------------------------------------------------------- ------------------------- -- ------------------------------------------------------------------------------------------.--------- -------------------------------------------=- -------- --- ----------------------------------------- Final Inspection b A - - -- - __________-D-a-te -------------------- SOACO LOCAL HEALTH DISTRICT f r` E. H. 9 1-'6B Rev. 5M