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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---- (Complete Pr, Triplicate) _-Permit No.a___,,� --------- --------------- ------------------------ Date Issued This Permit Expires I Year From Date Issued ----------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct.arad install the work herein described. This application is made in"•compliance with County Ordinance No. 549 and existing-Rules and Regulations: r -----CENSUS TRACT -------------------------- �JOB ADDRESS/LOCATION _____---_ - 11"f---0----------------Ff - - Owner's Name ° I',-6-q C_k----- --kAa �--------------------- ------------------------ --- --------- ---Phone --------------`---------------_--- . Address --•--• Cit C'rS; ``� j -�------------------------- -tD- -gr�± '`, .,'-------------------------------- v Contractor's Name .%Tu _ '�'------------------------------------ License #/L� � Phone _l "'"'� z " 44 Installation will serve: Residence U-Apartment House-F-1 Commercial ❑Trailer Court a Motel ❑ Other ------------------------------------------- e Number of living units:_-________Number o edrooms ____ _._..Garbage Grinder __._�ot Size -4'�-�-_�--��-------------•- Water Supply: Public System and name ----------- �. _. -- L�- - - ----------------- Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Cla Peat❑ Sandy Loam ❑ Clay Loam ❑ Y e ---------------------------- Hardpan ❑ Adobe' Fill Material�D-- If es, type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) seepage pit permitted if public sewer is available within 200 feet,) / NEW INSTALLATION: (No septic tank or PACKAGE TREATMENT [ ] SEPTIC TANK S' Liquid Depth ------.-•--- Capacity _ _. � -------.Type F -- 7Materi hNo• Compartments Distance to nearest: Well ____A ------ Foundation __-- Q______--___ Prop. Line __. __...:..__--._-17V _�--��y�Total,Len LEACHING LINE � No. of Lines __F� ------��_-___ Length of each e__.(_ -/-Y ----, -Length/__J_____..--------------- D' Box / -_ Type Filter Materi l _1-� -- ----depth Filter Material -- _ ___��-:_- •--=---------- I Distance to nearest: Well -- -- --------- Foundation---- ---------- Property Line SEEPAGE PIT Depth ----_--- Diameter ..:--_ Number -- ,: ------- Rock Filled let Yes No �] /1 Water Table Depth ..... yr -_9�=,--------------------------Rock Size h�`a•------------- Distance to nearest: Well ______ --------------Foundation -- �_____-.---- Prop. Line .._ .__----..-...-- r 1 REPAIR/ADDITION(Prev, Sanitation Permit# --------------------- ---------------------- Date ----- -------------------.----) Septic Tank (SpecifyRequirements) --------- ----------------------------------- ------.------------,..----------------------••--- Disposal Field (Specify Requirements) --_-------- ------------------------------------------------------- ----r ---•----------- ----------------- -------------------------------------------------------------- ------------------------ ----------------------------------------------------- -_ : - - (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 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." .� Signed ------ ---- ----------------- ------ --------------- ----------- Owner --------------------------------------- Title -- -------------- -------------------------------------------------- (If ------------- - ---- (If othe. n owner) EPARTMENT USE ONLY / APPLICATION ACCEPTED BY --------- - --- ------ e DATE I3 illi BUILDI,NG PERMIT ISSUED ----------- � ---------------------------- ------------------------DATE ------------------------------------------- ---- - ------ ADDITIONAL COMMENTS ----------- -------- -----------------------••-•---- ----------- --------------- --- --- ----------- --------------------- ----------------------------- ----------------------------------------------- --- -- -- -- ------------------------------- ----------------- ------------- ADate Final Inspection by: ------- N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M