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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ---- --------------------------------------------------- Permit No.0y (Complete in Triplicate) ---------------------------------------------------------- - I This Permit Expires 1 Year From Date Issued Date Issued 5o--5D ' 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 Mules and Regulations. JOB ADDRESS/LOCATIO „ -- --_-------- -- __-if ---.- ---aE'__�--------------------CENSUS TRACT _ - =------------------- Owner's Name .--#(21----- g = Phone Address - d `City - _ = PhoContractor's Name ------- - - ------ -License � e - -----------------'------------- Installation ------=- -= ----- Installation will serve- 'Residence Apartment House,❑ Commercial ❑Trailer Court ',❑ tl _Motel ❑Other ` ---------------------- ------- Number of living units:_---l----- Number of bedrooms 7Garbage Grinder ------- Lot Lot Size Water Supply: Public System and name --------------------------------- ------------------------------------ ------------------------------°-----------Private yti Character of soil to a depth of 3 feet: >aSand'❑ /Silt E] Clay E] Peat❑ t Sandy Loam ❑ Clay Loam:❑ a V _, t Hardpan ! Adobe ❑ Fill Material-=___ If yes, type ___-____-_-____-----_----_ (Plot plan, showing size of lot, lbcat on of system in relation to wells, buildings, etc. must be placed on reverse side.] NEW INSTALLATION: (N o septic tank or seep' a pit permitted if ublic sewer is available within 200 feet,) PACKAGt TREATMENT [�] SEPTIC TANK'( ':.` Size_-2__-l!___d_�._!r�_ ______ Liquid Depth -�41- /____ ----------- Capacity �.l E':' :_. ype Material__?- r---.-- No. Compartments aZ_ I Distance to nearest: 1�11e11 --_ �"_ O___--___'t"_._..Foundation --__--1.9__�______ Prop. Line ____S___ ________ LEACHING LINE , f No. of Lines ----------- ------------ Length of each line---- 4d_____-_--__- Total Length ---- _--------.---_... D' Box _{ .._ r. rr I -_.._.__ Type Filter Material--��-_ _DepfFi Filter Material __ ---------------- I Distance t`nearest: Well _ -`-7---- Foundation _____��_�___- :.Property Line ___S.................. ` 02 i �`3__f ____ Number _________ _.__`_ ' - Rock Filled%' Yes' SEEPAGE-10T Diameter _ __ __ ®�No I❑ [, f Depth I r Water Table Depth �1 Q----------------- ------- --------- --------Rock Size Distance to nearest: Well -----------,_9.0---------"+`------Foundation ----lQ----------- Prop. Line ..__--I------ ....... s i I REPAIR/ADDITION'(Prev. Sanitation Permit# ____________________________________________ Date __________________________________I SepticTank (Specify Rgquirements) -------------------------------------------------------------------------------------------------------------,•---------------- DisposalField (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 i 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: �.` "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner 1: asto 6eco a ject to Workman's Compensation Paws of California." Signed -------------------- ---- Owner 13Y =• Title ------------- (If other than owner] OR :DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY --------------------------- _._. DATE _ _-' -.f~ - ------------ BUILDING PERMIT ISSUED ----------- ------------ ---------------------------------------------------- - - - - --- ------DATE ------------------------------------------- ADDITIONALCOMMENTS ------------- ---- --------------------------------•------------------------------------------------------------------------------ --------------------------- ------ ---•-------------------- ---------------------------------------------------------------------------------------------------- ------------------------------------------ -- ------------------------- -------------------------- --------------------------------------------------------------------------------------------------------------------------------------- -- ------------------= ---- ------- - ----- . -------- ------- ------------'-------------------------------------------------------- - ---- Final Inspection by: - ------- ------------------------------------------------------------------------------- Date ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 i-'68 Rev. 5M. I.- ,