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i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT = - ------ (Complete in Triplicate) Permit ---------------------------------------------- --------------------------------------------------------- Date Issued ---�� 1 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: '_ -•� b - CENSUS TRACT JOB ADDRESS/LOCA710Nw,__ : ___ - - Name __ 4f ------------- ------ ------,Phone r—e? 0600- ------ Owner's f ------------- --------- - - ---- - ---- --- Address ' � i - -----•--. City \ ; Contractor's Name ---------------- ---- _, tf '1!!_----- ------�---License # j- ��_- --- Phone _7 _i �� 7 } -- --- -- - - ----- . Installation will serve: 3 Resid,�cn 6Apartment House❑ Commercial❑Trailer Court ;❑ Number oftlivin .units: ��-____,Numbe Motel ❑Other -------------------------------------------- living ___ _ _________________________ a M g { r of bedrooms ___ ____Garbage Grinder _____-_, Lot Size -_ f x�/0 ____________ Water Supply: Public System•and nam_ a 1- --------------------------------- ------------------------------- -- _ ,----------Private ❑ Character of-soil1to a depth of'3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay--Loam:❑ i l j Hardpan ❑ Adobe 9 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,) J� i PACKAGE TREATMENT [ – SEPK S•ze_______�-X- ___-_„______________._ Liquid Depth j 1 Ca aci r:,',___ Type 1 --.-__ Material__ _r_. No. Compartments }� Distance to nearest: Well ------------------------------------Foundation ----,LO___ ---_-- Prop. Line _--a." .:..f"..... LEACHING LINE No. of Lines ---'I,__o7 ._----------- Length of each line-------3" -.---------- Total Length _____17743_`_--__-__-- 'D'--.Box—___t7 Type-Filter–Material W_ __Depth Filter Material ____J9_��_____________________________ Distance to nearest: Well ____________________ Foundation ----1.0_-4------- Property Line ___-�.............. k p i Rock Filled Yes No SEEPAGE PIT k� � Depth �� '; ---- Diameter _ __3_.______ Nuimbe, ____,_.____�_�.__ - 0Water Table De' -----------------------------: Rock Size l Depth , Distance est: Well -------'-------------------------'__ Foundation_ ��`---- Prop. Line --------------- REPAIR/ADDITION __- ---- REPAIR/ADDITION(Prev. Sanitation Perm # --------------------------------------------- f Date --------------------------.._..---} f Disposal Feld (Specify Requiements---------------�--------------------------------=------------------------._----------------------------- -,----------------------------- P P YRequirements) } -------------------------------- -°-`� ---------- ----------- ---- - ___________________ ______________ _________ _________ __ __________________________ ________________________ _ _ ______________________ __-----------------__-------_____-_____________________________________- __ ____________________________________._,_____ (Draw existing and"required addition on reverse side) I hereby certify that I have prepared this application and that the work willb d ne 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 become subject to Workman's Compensation laws of California." Signed -------- ----Owner, . , i(� BY / :_ ----------_ Title ex-(If oth t an owner( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- ---------------------------- ------------------------- -------- DATE d. ------- ----------- BUILDING PERMIT ISSUED --------------------------------------------------------------- - -------DATE ,------------•---- -------------------•-� ADDITIONAL COMMENTS ------- ----------------------------------------- ------------------- --------------------------;.F-------------------------------------------------------------------------------- - (Y ------------------ -- ------------------------------------------------------------------- -- ------------------------/� ---- Final Inspection by. : - -------------------------------------Date �� j SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M #