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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,., ------ Date Issued (Complete in Triplicate) Permit No: _.______`____._. ____,___._______________________________________ _______ 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: / J. JOB ADDRESS/LOCATION^ _ -`�------- - - -----✓P a yv ---------------------------------CENSUS TRACT -------------- ----------- Owner's Name --- ------- --�----- -------Phone._ ------------------- ------------------ �-- v ----- -- ---------------- city f L_ ! 1 _L7�' -] Contractor's Name ...0.1N7 ._�� -------------------------------------------------------_:________.License # ____.___;____________ Phone _____________ Installation will serve: Residence ❑ Apartment House-E] Commercial :[Trailer Court 0 Motel ❑Other -------------------------------------------- Number of living units_____________ Number of bedrooms ------------Garbage Grinder ____________ Lot Size 122x2?6 3X1 QX1��i Water Supply: Public System and name -Cr_•�_ ----- - ---------------------------------------------•--.-----.------.Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam,, Hardpan ❑ Adobe'D 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------------------------------------------------ Liquid .Depth --------------------_..._-- � Capacity -------------------- Type -------------------- Material------------------ --- No. Compartments Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------7------ / J...... LEACHING LINE J� No, of Lines __--1----------------- Length of each line.._____i�__l1_ --- ------ Total Length ,____�_� 'D' Box ------------ Type Filter Material ____________________Depth Filter Material ____________________.__ _ Distance to nearest: Well ------7�_________ Foundation , 46_I/- -----_ Property Line --------------- SEEPAGE PIT [k] Depth ---/_0--------- Diameter __. _ ------ Number ---_/_1-____-____________ Rock Filled Yes '❑ No k s Water Table Depth -----------�A---/-----------------------Rock /-----------------------Rock Size -------------------------------- / s Distance to nearest: Well -------- _________________________Foundation __ `__________ Prop. Line ------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ___________________________________________ Date __________________________________} Septic Tank (Specify Requirements) -------------------- ----------------------------------------------------------------------- ------------------•------ Disposal Field {Specify Requirements) ----------- ----------------------------------------------------------- ----------- ------------------------------------------------_ --------------------------------- ---------------------------------- -------------------- (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 Gam"' - ----- ---------------- Title --- ------- ------ ----------------------- --- ---------- ---------- (If other tha owner) FOR DEPARTMENT USE NLY APPLICATION ACCEPTED BY 12 ----------- - DATE - -------- BUILDING PERMIT ISSUED --------------------------------- - ----- ------ ------------------------------- ----------------- --- ---DATE -------------------------------- ----------- -- - ADDITIONAL COMMENTS ---------------------- ------------------------- ----------------------------------------------------------------------------------- --------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- t - - - - ----- Final Inspection by u- ----------- ------------------------------- -------Date - -- ------------- �-- --� 3 Q ---- ---- - - ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M