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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- I I Permit No. • (Complete in Triplicate) ---------=---------------------------------------------- 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 and install the work herein described. This applica+;^^ - "e irj c- npli nce with CouOrdinance No. 549 and existing Rules and Regulations: Erb tat V>�.55n!� Ott R-T"r f JOB ADDRESS/LOCATI t `---_--.---� ------------1 c _�_�' ---/=sJ -I- ...........CENSUS TRACT ---- s --- Owner's Name - - �u'#�-ems - - -�fc<Y--------------------------- - -------------.P`hone --��--" -- ..,.�.---•- } 1 1 ---- ----------------------- City -------- ` -� G `�' = Address �---------- -------- -------�`41��- --------------------------------------- Contractor's ----- - • -•- •-------•------ Contractor's Name ------ c-- � ------------------------License -------- Phone Installation will will serve: Residence [,Apartment House❑ Commercial []Trailer Court Motel ❑ Other -------------------------------------------- Number of.living units----- ------- Number of bedrooms ----_.__Garbage Grinder ------------ Lot Size --------____________________________________ 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,) if IS'S PACKAGE TREATMENT [ ] SEPTIC TANK Size--------- Liquid Depth �. --- y # C acity ___l _-___ Type R7�__C_8__s __ Material------C'u orf No. Compartments ________________ � r is once to nearest: Well ____: �______________________Foundation -_1� __._.._.. r Prop. Line _1 ___-------- LEACHING LINE No. of Lines ,. .. 4 g Total Length 3------------ Length of each line-----------70 0---U•---------------- 'D' Box --__---.--- Type Filter Material ----Depth Filter Material ___,f57_________________________________ Distance to nearest: Well ------------- Foundation _.-__1 ---(--------- Property Line ___ _. ..... SEEPAGE PIT [ ] Depth --- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well _____________________________.______-_Foundation -------------------- Prop. Line _.--____..___________- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ________.____.__,_______.______---) Septic Tank (Specify Requirements) ___________________-------------------------------------------------------------- Disposal Field (Specify Requirements) _____________ _ i _- � 4 1-,s ____--------------__________________ _____ __._____-___-----------------------------------------------_ _ ____--_-------_---_ ___ ------.-----------___-._ _-________-___________ ywok _____.____N---------------f---------------._.----_---___________------_- �._-.__--.-.___-.___�'_____.___._____.-_________._____________________________.__.___.___________._____________-______-______ (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 w ich this permit.is issued, I shall not employ any person in such manner as to become subject o Wo kman's Compensation laws of California.." !,` � ' ' Signed _ _ __._____ _._-__-___ Owner By ----------------------+----------- ------------------- ----------------------------- nitle ------------------------------------------------------------------------ (if other than owner) FOR DEPARTMENT USE ONLY �r APPLICATION ACCEPTED BY ._._ - t CJr------------------------ - -- __ DATE7rZ BUILDING PERMIT- ISSUED` _- ------ -------------- - ---DATE ----------------------------------------- COMMENTS _t ------------------------------- ----------- 4- ADDITIONAL -------------------------------------- ----------- ---------------------------- -- ------- - -------------------------------------------------- - ---- ---------- --- ------------------ - -------- --- ----- -- --------------- --------Final Inspec b ------------------------Date .--- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M