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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - -------- --------------------- Permit No: 7d4fK7 (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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: i k CENSUS TRACT ------------------------- JOB ADDRESS/LOCATION __�e��y� d __ __��` :�-�'-�--�----�------�----•---�--- --- - Owner's Name f� ---------- Phone "�i -�� Address City CSP , Contractor's Name -------- f� Phone .License # _r "_` l _ _ Installation will serve: ResidenceWApartrnent House,❑ Commercial ❑Trailer Court i❑ Motel ❑ Other -------------------------------------------- s � Number of living units:---- .--- Number of bedrooms -._----Garbage Grinder ------------ Lot Size _._- _ -.---- Water Supply: Public System and name ------------------------------------------------------------------•------------------------------------------PrivateX Character of soil to a depth of 3 feet'' Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan 3❑ 'Aclobe//`V Fill Material ------------ If yes,type -----------------.---------- I (Plot plan, showing size of lot, location of systemdin relation to wells, buildings, etc_ must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted ifyublic sewer is available within 200 feet,) 0 PACKAGE TREATMENT { ] SEPTIC TAN re .07` -` �f�Y.- -------- Liquid depth _____ ------_- i Capacity;6-U „-- Typp __=-___ ___ Material ----- No. Compartments -------- -----�-- i Ul Distance to nearest: Well ____+.` __--________________Foundation __ - -________ Prop. Line ------ ---- -- LEACHING LINE )< No. of Lines -------/------------- Length of each line-/400-1-------- Total Length ....Ile-4 'D' Box ------------ Type Filter Material ! Q_Cepth Filter Material ----/X-- ----------- -�-- ---------� �'"" Distancerto ne arest:,Well -----------»-Foundation __rj ------------ Property Line SEEPAGE PIT Depth -- --*�-------- Diameter��6________ Numbe; _-____. -- ___.__ ___ Rock filled Yes No p.. Water Table Depth -----7 Rock Size ` d R � +� Distance to nearest: Well . _+ ___________________ _____Foundation _--__-- Prop. Line ___,' __.._.. .a t �=—� REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __;*_,..___________:____________-) � Septic Tank(Specify Requirements) ------------------------__ k 4- --------------------------- Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------ T � 9 -----------------------ISI----------------------------------_-------------------------------------------------------------- y" -------------------------------- ---- -------- ---------- (Draw existing and required additionon.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 which this permit is issued, I shall not employ any person in such manner �. as to b me uhject,toJWork n's Compensa`i .n laws of California." Signed -- ----�"�---- Owner By ------------------- ----- Title-------------------- Title ------------------- (If other than owner) s F DEPAOTMENT USE ONLY APPLICATION(ACCEPTED BY ,-► -- 1__------ ------• DATE -��-_ f - ---- ------------ - ----- - -- --------------------------------- BUILDING PERMIT ISSUED -------------------------------------- - DATE --------- ---------------------- ADDITIONAL COMMENTS ! -- - - -- - ----------- ---------------------------------------- -------- ---- -----. t ------------------------------------------------------------------ . �. y F f -----------i- ----------------------- `='--- ---------------- --------------------`l------- ---------=------- Final Inspection by ��' --- - - -----------------------------------------------.Date -- -------J-- - ---------------------------- - - ------------------ N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M