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FOR OFFICE USE: APPLICATION'FOR SANITATION PERMIT --------------------------=------------------ - (Completein Triplicate) Permit No. ------7-3 This Permit Expires f Year From Date Issued 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 pOrdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION Q._ _ �7-QTl - _-_______.____._ -- --- --------------- TRACT Owner's Name ,_ I-.�-._ /? --------------------------------- -- Phone Address ._l d ..l l? � � -!_ --------•--. city ------72/_Y-e-�f--------------------------------------- ------ Contractor's Name --------------------------- ----- ----.License # ----------------------- Phone ------------------------------ Installation will serve: Residence 'Apartment House❑ Commercial ❑Trailer Court ;0 Motel ❑Other -------------------------------------------- Number of living units:----- ----- Number of bedrooms �-----Garba_ge Grinder ----------- Lot Size—k_,6�-�--- Water Supply: Public System and name -------------------------------------------- ----------------------------------------------------------------Private. Character of soil'to a depth of 3 feet: Sand'❑ Sift❑ Clay ❑ Peat ❑ Sandy Loam -�S- Clay Loam El Hardpan ❑ Adobe-E] 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,] \f1 PACKAGE TREATMENT TANK'[ ] Size_.. )(__3___ ------------- Liquid Depth Lon ef�� Capacityf e?j Type UI)eMhMaterial----- No. Compartments ___-------_______-_.- Distance to nearest: Well ---�4�_____________________Foundation . _ ------- Prop. Line _ ________ .011 LEACHING LINE [C�No. of Lines -- ------- ---- Length of each line------ ---- ------ Total Length _ ,_...__ D''9"l Y.�i� e / ax __ __._.___ T Iter Material r'�IU -C____Depth Filter Material __ -_______...__-------- Distance to nearest: Well / Z-)_l--------- Foundation ----- ---------- Property Line. ___ s / --" 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 ----------------------------------) w Septic Tank (Specify Requirements) -------------------------------------------------------------------------------------------------------------- -•--•- {' Disposal Field (Specify Requirements) -------------- ----------------------- --- ---------------- ---- ---------------- -------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 which this permit is issued, 1 shall not employ any person in such manner as to become subject;o %rkman's Compensation laws of California." Signed --- ------------------------------------------- Owner BY --- ------------------------ --- ---------------------------------------------- Title --- ---------------- --------------------------------------------------- (If other than o er} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ------ -�c------------------------------------------------------- DATE ----- 7— ------------------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------=--------------DATE ------------- --------- ------------------ ADDITIONAL COMMENTS ----------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ________________________________________________________________________________________________________________ ___ _ 1 Final Inspection b _______Date SAN JOAQUIN LOCAL HEALT . !STRICT E. H. 9 1-'68 Rev. 5M.