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FOR OFFICE USE: PLICATION FOR SANITATION PERMIT q ------- - -- ----- Q nJ (Complete in Triplicate) Permit No_ __________________ --------- �® This Permit Expires 1 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 County Ordinance No. 549 and existing Rules and Regulations: // r d j ,,,,( 'J� f�,��Il t� � S s� JOB ADDRES /LOC, ON ._- ' / 1Z_t . - _ , Q t_l._.= C1..T f S TR C7 - j --- Owner's Name _. 1T ------- ------------------------------------------------------ - ---------------Phone ------------------------------------ Address ----- ---------•-•----------------------- Address _..-----9-//7- -- - i --17-)2 --------•- City '�J �3f1� � ------------------- -------•---•---•-- -- --- - Contractor's Name ----L'.�"_�. _.r---- - (---------------------------------License #. _ cJ.ti-V 87'--Phone ------------------------------ Installation will serve: Residence fj Apartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units------------- Number of bedrooms ____________Garbage Grinder ----------._ Lot Size -- CBF/}_ --------------- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'�Z Silt❑ Clay ❑ Peat❑, Sandy Loam -E] Clay Loam ❑ Hardpan E] Adobe ❑ Fill Material --- v-- 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:[ ] Size___________________________ ____ _____________ Liquid Depth _______________-__,__-_- Capacity -------------------- Type - ----------------- Material-------------- ------ No. Compartments -----------------••--- Distance to nearest: Well _ _-________-Foundati n ______________________ Prop. Line ______--____.:--.__-__ -------------------- - LEACHING LINE [ ] No, of Lines _______________________ Length of each line______________ _____________ Total Length ._____._ .................. D' Box _-___- Type Filter aterial ____________________Depth F ter Material ____.__________________________________-•- Distance to nearest: Well __ _____________________ Foundation ------------------------ Property Line ------------------------ SEEPAGE ________________ ._._SEEPAGE PIT [ ] Depth Diam ter ________________ Number _._.____. .___..________ Rock Filled Yes ❑ No C1 Water Table Depth ----- -- - -----------------------------------Rock Siz -------------------------------- Distance to nearest: Well __________________Founda ic n -------------------- Prop. Line _.___...__........._.. REPAIR/ADDITION(Prev, Sanitation Permit# _____ I/e -r Date ___ ____________._____________) Septic Tank (Specify Requirements) ------------------------------------------------------------ -------,-------- ----------------------------------------------•----•-------- Dii/s�poo�sal field (S cify Req irements) -FRe- -/��..--- = 1_/- ----- 1 I� -------- ---------------------- -zdC� p --------------------------------- r / ---------------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 and Regulations of the San Joaquin Local Health District. Home owner or lken- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such spanner as to become subject to W rkman's Compensation laws of California." Signed . .. . -- -- -- Owner - By ---- ---- -- Title ------------------ -------------•--------------------- (If other than owne I _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- •- ---` 1�I- _______C, Af`�E---I --..LO-- -----------. DATE ------ - - ---- ----- ----------- BUILDING PERMIT ISSUED ------------------ �1f�r`-vk ----DATE -------- ADDITIONAL COMMENTS ---------- ------------------------------- - --------------------------------- ----- --- ----------------------- ---- ----- - --------------------------------------------------------------------- ----------- ----- -- -- ---- - ----- - -- ------------------------------------- Final Inspectio ____Date ---- = a� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M