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FOR OFFICE USE: APPLICATION FOR-SANITATION PERMIT Permit No: --------------- (Complete in Triplicate) This Permit Expires 1 Year From Date Iss y �te Issued ___.-__�._____ . -. --------------- -_------__-------------___----------_ Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is m ,'adc I' P3,rith County Ordinance No. 549 and existing Rules and Regulations: ,7 / -5. ® -----------------------(��'� 1474 E SUS TRACT 5. --- ..- JOB ADDRESS/LOCATION -��-____-------------- Owner's Name L .-' -/ _f-�----------------- Phone •--------=------------------------- ------- ------ Address -----2 f�'-s e ---,----&&-------- A�— J� ----------------- City ----4, ----- ----------------------------------•-•---- 7 Contractor's Name ----- -----------------------------------------------------License # = :-------------- Phone ..---------------------------- Instailation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ;[] Motel ❑ Other -------------------------------------------- q Number of living units:--/ Number of bedrooms ____________Garbage Grinder ----__.__._ Lot Size -. J �---------•---- Water Supply: Public System and name ----------------------•---------•------------------------------------------------ ------------•------------ Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peau Sandy Loam E] Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ------------------__________ d (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 -----------•------------- Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ------•---------- -9 Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop.'Line ---------- :.------- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ----------- ------------ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ------------- -------------------•--------• ?j - ----------------------- Pro Line ------------------------ S� Distance to nearest: Well _____________________ Foundation party Li . SEEPAGE PIT [ 1 Depth ____________________ Diameter ---------------. Number ---------------------------- Rock FilledYes No i0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance --------------------- ---- -- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop.11ine --------_--------_-- REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------.---------------------------} Septic Tank (Specify Requirements) -------------------------------------- ----------------------------------------------:---------- j/ Disposal Field (Specify Requirements) ----- � -------- -- ----X-----------? `f -------------------- ------------- --------- ---------------------------------------------------------------------------------------------------------------------------------------------------- -----------• ----------- ------------------------- ----------------------------•---------------------------------------------------I----------------------------------------- (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance:1 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------------------------------------------------------------------------------------ Owner By ----- ------------------ --------- ------------------------------------------------- Title _----=---_--- -------------- ---- -------------------- --------------- (If other than owner) FgVR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYc__ _ fir ____ ______________ ._ -, -.-7/ - - ---------------- -- --- ------------------------------ DATE -----=-- ��---- ----------------- BUILDING ------- ------• BUILDINGPERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE - ------- --------------------------------- ADDITIONALCOMMENTS ------- ------------------------------------------------------ - --------------------------- -------------------------------•----------- 1 ---------------------=--- --------------------- " - � ------ --------- -------------------------------------------------------:----------------------------------�--- -------•------------------- ------ ------------------------------- --------------------- ------- -------------=---------------------------------------------------- - - ---- `--------------------------------------- -------- -------- - 77/ Final Inspection by: ------------------------------------------------------------ s SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 - 1-'68 Rev. 5M " F ,