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FOR OFFICE USE: - -7D-- 2.30 APPLICATION FOR SANITATION PERMIT _,�, _, 2 � - ................ . • .............._..._- Permit o. . . . (Complete in Triplicate) •- �•��•.- �----- ......... ....................................... _ Date Issued This Permit Expires l 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 ismade in compliance �with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO _eY45-�- -•-y/ 1 .......... ....._.. CENSUS TRACT ". Owner's Name ..... . .. .. Phone 73/:7 ..7. , .4P..---- Address _..------------------••- Q•% / ........ _. 1-....-. -. .. .......City .................. ....... Contractor's Name_._..._.. ...... . L2 ------ d am! - License #` lJ' Phone .�J— Q . Installation wi11 serve., + Residence([Apartment House C] Commercial QTrailer Court Q ., Motel.❑Other........... Number of living ugits:_.___4-____ Number of bedrooms :`..'Garbage Grinder ------------- Lot Size ""7...... Water Sup Public System and name ---------------:--------------------- -- •---•-:-:-.--.---.._.._....-..-------------- ........................Private .c......t 7k Character of soil top depth of 3 feet: Sand's Silt❑ Clay�i], Peat Q Sandy Loam Q k Clay Loam Hardpan C] Adobe Fill Material ._.......... If yes,type ......................-_-_-- (Plot plan, showing size of lot, location of system in relatiomtotwells, buildings, etc. must be placed on reverse side.) p� NEW INSTALLATION: (No septic tank or seepage pit permitted if public.sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK1 ] - "' Size.'=:.............:... .................-.. Liquid Depth .. ..........._........... Capacity ------ Type .................. Material...................... No. Compartments \ Distance to nearest: Well -------------------------- - ....Foundation_-,___...------------- Prop. Line__-_................. LEACHING LINE [ ] No. of Lines _-..-_................ Length of each line....................I....... Total Length v 'D' Box ....--..---- Type Filter Material ............. .Depth Filter r Material .....-:_._______----_-..._----_-.___--. Distance to nearest: Well .................... Foundation ..__-------------.------ Property Line ......................... SEEPAGE PIT [ j Depth ........... Diameter A.......�_, Number ............. Rock Filled Yes (] No C Water Table Depth ..................................`'_4_-_ _.Rock Size............................... a r Distance to nearest: Well ....................................`_...Foundation ...... ..... Prop. Line,........`.:............ ' V REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------- _---.---........_. Date .....t..............___---_-.-•) , Septic Tank (Specify)Requirements) ............ - . .... . --_--- _ _......... :. Disposal Field (Specify Requirements) ry 7T /.fQ.>�..._.-. ................." . -- . . .. _ - --- - ..._....'-......:�----------------� ` C�1 .�!?-y ---._. ' '- ----- �. X2 Y-. ----- ------ -------.... - - _ ---------------=--------------: ----------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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- '��" 11 1 i "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 Wetkman's Compensation laws of California." y_ Signed ................. ....Ithwner) --- ---------•----__. ... Owner By ................... ..._ Title . if o e FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .......................................----------- ..... DATE ... . 7�_Z..Z 7------------- BUILDING PERMIT ISSUED.........� ' `T -----•- ..............DATE ..... ............................ ADDITIONAL COMMENTS... ........... -------------------------------•----.-__ _. ---------------------• •-----....--------._......---.................... --•.... .. -- ....................--------- ----•--•---•------------ ..........I——........................... -- ----- ---------------•------"---------------..-_.-.-•----•-------•-.----------•---- -------- -- -- --- ----------------------------- .-.--.-----•---------------•....- Final Inspection by: - •-----• Date 2 .:7� ................ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M ;.t•�: '�