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FOR OFFICE USE- .a- SE:.a- APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. . .{fit Date Issued ��-�5-""7 __.__" _______ 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 ds made in co pliance with County Ordinance Na. 549 andexistingRules and Regulations: JOB ADDRESS/LOCA;IInOf� -------5.---- CENSUS TRACT - - Owner's Name v .w�"Q ,------------------------------------------------------------- ------------------.Phone._4d-_9 649-------------- Add ress?01�!___ -_ {J,." ---------------------------------_- Cit Contractor's Name -- - --------------------------------------------------------------- ---------.License # --------:-------------- Phone ---------------------- Installation will serve: Residence Apartment House❑ Commercial []Trailer Court i[] Motel ❑Other Number of living units:----- ___._ Number of bedrooms ---I_______Garbage Grinder ------------ Lot Size ----_Id`rh 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 ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK, ] Size--------------------------------------------- -- Liquid Depth ___________-_______,___- U CapAlty ��{�- Type 4_ �___�*' Materials c�4._-__. No. Compartments 2--_ Distance to nearest: Well _9T111d_�—---------_------------Foundation AD.............. Prop. Line ____��N----------- LEACHING LINE [ ] No. of Lines ------I -----_-__-- Length of each line-------S6............. Total Length ---- ....--............... i 'D' Box Type Filter Material �tc . Depth Filter Material -----l.L_ ------- _ Distance to nearest: Well ___ fi?�.---------- Foundation .10 r`---_______.__ Property Line --- _�_______________ r SEEPAGE PIT [ ] Depth __95--_------- Diameter _ _ _______ Number ____---1___________ ____ __ Rock Filled YesX No �❑ le V a Water Table Depth --- 5---------------------------------------Rock Size i Distance to nearest: Well ------- -----------_._Foundation __I�_______._. Prop. Line ___.Jr. ___._-___-_-• REPAIR/ADDITION(Prev. Sanitation Permit# _________________ _ _---------------------- Date _______-__- Septic Tank (Specify Requirements) _________________________-_ Disposal Field (Specify Requirements) -------------------------------------------------" ----- ---------------------------------------------------- ------------------------------------------------------ ------------------------------------------------------------------ -----------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 licen- 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 manner as to bac subject to_ Work n's Compensation laws of California." Signed Owner By ----------- - --------- ----------------- --------------- ---------------------------- Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- - ------ --- ---- ------------. DATE BUILDING PERMIT ISSUED DATE ------ADDITIONAL COMMENTS . (��-----------L1 --- - - -- ---- - -------------- ---------------------------- ------------------------------------------------------------------------------------ -------------------------------------- ------------------------------------------------------------------- --------------------------------------------------------------------- ---------------------------- ---- -- ---------------------------------------------------------- ------------------------------------------- Final Inspection by: -----Date ----� SAN,JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M