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NP FOR OFFICE USE:- '• APPLICATION FOR SANITATION PERMIT ---------------------- --------------------- Permit No: o a '` • j (Complete in Triplicate) A.-flo This Permit Expires t Year From Date Issued Date Issued p� Application is hereby made`to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application jis made in compliance with County Ordinance No. 549 and existing Rules and L Regulations- ---- TRACT _..JOB ADDRESS/LOCATION IS7 - ..... Owner's Name -------IVAN---------819-SFil - --------------------P one ------------------------------------ ----------------- - ------- Address ------ i CAM -- Cit �CA- Contractor's Name --- ---------------- `-----------------License # --------- -------------- Phone ------------------------------ Installation will serve: R siesie de 'ce ❑ Apartment House❑ Commercial :[1Trailer41@0M- � Motel []Other ----- --- ------ -------------------------- Number of living units:-----l--- Number of bedrooms __..Garbage Grindery+ �_ Lot Size ----------- Water Supply: Public System and name --------- - --------------" ----------------------------------•----•----------------------------------Private Character of soil to a depth}of 3 feet: Sand'[] Silt-C] Clay ❑ Peat ❑ Sandy Loam ❑�Clay-Loam Q -o' 1 i Hardpan Adobe ❑ { Fill Material ___________ If yes,type ____________________________ U ' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) w NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet41 ,I PACKAGE TREATMENT ( ]?E SEPTICTANK'V� Size Liquid Liquid Depth ._-_- lf_____________ Capacity _l. 0cQ_' Type 10YA-5—n Material fi "La�lo. Compartments Distance to nearest: Well -_-____ --___________Foundation __._--__^~__ Prop. Line � ------ - -- ' LEACHING LINE No. of Lines -____—------------ Length of each,line-------9( _____________ Total Length _Ire-._______.____ �� Type Filter'Material _ ' X De _--r D' Box/ - �_ pth Filter Material �r Distance to nearest: Well -3co__"� _.__ Foundation __1 __" `____ Property Line ______________ _ ___ t SEEPAGE PIT f�� Depth ____J_2_,�''�Diameter -X-,ht�:Number ---_-- /--------- ------ Rock Fille Yes No Water Table'.Depth _------ -. ----- _-_. Rock Size _ -- _ 2, -2— I y ---- .._Foundatio Distance to nearest: Well -------LPl�____ `f-____ _M-4—_ rop. Line REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------- Date .............-.................... ) Septic Tank (Specify Requirements) ---------�1_ Disposal Field (Specify Requirements) -----:----__ - ----------------------------------------------------------- R J A , ----___-------------------_---------------------------________________________________________________________________________________,.._Y--------------------------------------.------------------------ rI (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. Horne owner or licen- sed agents signature certifies the following: k i "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner i as to be co ct to W man's Compensation laws of California." 1 Signed _ _ _ Owner BY --------------------------------------------------------- ------- - ` ;title --------------- - - - - - ------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------F-` ---------------------------------------------------------------------------- DATE .-/0771�y_''7a--- ---- BUILDING PERMIT ISSUED ' ------DATE --------- - 4.--------------- ADDITIONAL COMMENTS __.. _,. t�_ C � ( _!�f/)_ — _I11 I - =-----=----------- - - ---7Z-(----'-� - - :.) —_ C C. P _ --------------------------------------- --------- --------------------- - ---- - ------ -------------------------- Final f r � --------- ----------- --�-- ------ - ----- - ------ - _ ._ = ' Final Ins - - � `- � � --------- --- ------ - ------- -- -- ------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M