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FOR-OFFICE USE: APPLICATION FOIL`SANITATION PERMIT ` --------------------- ----------------------------- 1. — -.. .:le , Permit No. - (Complete in Triplicate) ------=---I---------------------------------------- ___---�' This Permit Expires 1 Year From Date Issued Date Issued _ :_____Y 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 7- h ----- ------ --- -----CENSUS TRACT -------------- ----------- Owner's Name ------ r _ 6e Phone 4 Address �?'fl------?U----------=e` VAV .. City ----------------------------------- ----•-- , Contractor's Name ------& / .r�.r !__- � �-----------License # - f12 ---- Phone _= f .-�" Installation will serve: Residence ❑ Apartment House-[J Commercial Xl railer Court ,❑ I I Motel ❑ Other -------------------------------------------- / f Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------- Lot Size __________------_-___-_______ ------- Water Supply: Public System:and name ------------------------------------------------------------------------ --------------------------- --------Private Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ _-___Sandy Loam -E] Clay,Loom.'[] F ,_ i ardpan ❑ Adobe HFill 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.) V ii NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( 7 !!SEPTIC TANKICfSize__ ----- - --------- Liquid Depth ------------- Capacity ----- Typep,4_444— Material ----- No. Compartments ___ ----------- Q. Distance to nearest: Well ---------'S—Z)----------------Foundation d__Q_-_--__.Prop. Line _'__......... LEACHING LINE No, of Lines __ ------------ Length of each lin e.1Q6._--------------- Total Length -----1:M _�_____-- 'D' Box ._.__l.___ Type Filter Material 56-_/_p�"a�� Depth Filter Material -----/Z?------_______________________, 1 � Distance to nearest: Well ------ �__------------ Foundation Property Line SEEPAGE PIT [ j Depth --------- --- ------ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No .i❑ WaterTable Depth ---------------------------------------=-----=--Rock Size --------------------_--- Distance to nearest: Well -------------------------------------EI.Foundation -------------------- Prop. Line -------------=--•----- REPAIR/ADDITION(Prev. Sanitation Permit r# ------..------------------------------------(Date ____--..____________----__-__-___-1 i Septic Tank (Specify Requirements) ---------------------------- � ----------------------------- t Disposal Field (Specify Requirements) --------------------------- ----------------'-=""""'--------------------------------------------------------------- --------------- ------------------------------------------------i i (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 be a subject to,W rkman'compensation 1 s of California' ` Signed ------- — ------ Owner By :I ��¢ _ Title -------- --------------- y ' ------------------- - ---- (If other than owne q II FPR DEPARTMENT USE ONLY ----------------------------- DATE --S'-_ ` "�G ------------..-------- BUILDING PERMIT ISSUED ------ ------ - - ---- APPLICATION ACCEPTED BY _ --------------------------------- ------ - --------�------------------------------------------- DATE ------------- ----------------------------- ADDITIONALCOMMENTS ---•i----------------------------------------------- ---------------------------------------------------------------------------- ----------- ---•----------- ----------------------------------- ---------- --------------------------- ------------------------------------------------------------------------------------------------------------------ ------------------ ------- ----- ---------- ---------------------------------------------------------------------------- --------- Final Inspection bY: -----------------------------------------------------------------------------Date - �� SAN JOAQUIN LOCAL HEALTH DISTRICT �``E. H. 9 1-'68 Rev. 5M 4