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FOR.-OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- (Complete in Triplicate) Permit No. _ _________________. r -.-------_-__------- l This Permit Expires 1 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 madelin compliance with County rdinance No. 549 and existing Rules and Regulations: a t z, (— JOB ADDRESS/LOCATION . �7 - -�------- - ------------ ------."`---------------CENSUS TRACT Pf------------- ---...----- Owner's Name -------- --------1-- '�^ ----------------- ----------Phone= i�r�5 ' 319 Address ,.• -- -- f 0� --- City -1 {�� ------ V Contractor's Name ---r_�A --va -License # Phone Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other --------h/C'-_f01��---------.- Number of living units:--7---- Number of bedrooms -----------Garbage Grinder .------------- Lot Size ____________________________________----. I -� Water Supply: Public System and name ---------------------------------- ---------------Private ❑ Character of soil to a depth of 3 feet: Sand F Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ Hardpan ❑ Adobe❑ 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,) F PACKAGE TREATMENT I ] SEPTIC TANK[ I Size------------------------------------------------ Liquid Depth ---___--___-_____________- .! 1 Capacity ,I ---- ----- --- Type -------------------- Material-- ------------------ Compartments 44 -----------•-• -- Distance to i nearest: Well __________________________________ _ oundation _. ------------------ Prop. Line ________-_______------ ' LEACHING LINE [ ] No. of Lines ________________________ Length of each ne------------------ --------- Total Length ---------------------------- M 'D' Box ----'1------ Type Filter Material --------- ---------Depth F' er Material -----------_--_--------------_-------------- Distance to nearest: Well _______________________ oundation - --------------------- Property Line ---_-_--_-...._.__...... SEEPAGE PIT [ j Depth -------I------------ Diameter _________ ______ Number _ -------------------------- Rock Filled Yes ❑ No Water -Table Depth ---------------------- ---------------•------- ock Size -------------------------------- a Distance to nearest: Well __________ ________________________ ___Foundation ---__.__-.-_- ------ Prop. Line ---------------------- d REPAIR/ADDITION(Prev. Sanitation,Permit# -------- -- ------------------------ _ Date ----------------._-______.___-___.) ,t Septic Tank (Specify Requirement's) -----_-------_ Dispos Field (Specify Requirements ---------------- - -:- ------------ ------------ ----------- _ � � � -- /_ �'� ----, 1-e---��'__� �s �------•----- � j - --------- ------------------------------------------------------------------------------------------------------------------------------- - (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, I shall not employ any person in such manner as to become s�ubject.to W rkman"s Compensation laws of California." Signed __ __ -_. _ Owner - ------------------------------------- '� L [ - BY j Title --------------------------------------------------- (Ef other than own r) FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED 8Y ------------------------------------. DATE ------��,._�R_�.h-_.I-_... 1. BUILDING PERMIT ISSUED -----------------------------=---------�-------DATE -------------•---- ------ ADDITIONALCOMMENTS ----------------� ------------------ ----------- ------ ------------------ ------------ =-------------------------- ' I ------------------------------------------------------- -- ----------------------- -------------•-------------- -------- ------------------------------------------------------------------------------- Final inspection ------ SAN ` JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M 1