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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -7 G Permit No. .-I--. --_-0_- '. "",-------------�- - {Complete in Triplicate} ------------------- ------------------------------------ Date Issued This Permit Expires 1 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 incompliancewith County Ordinance No. 549 and existing Rules and Regulations: --- y7_- -------CENSUS TRACT ---------------------_--- --- JOB ADDRESS/LOCATION .-- - .- �0.19 ---------------- Owner's Name /" ' - -r C A i+T -- ------��)��--- ---- - ---------- n� Phone Address 1 r��5 --�----�� l -�;l/-`�--vim. City 1 "► �� Contractor's Name -..- License #�-3,_3�-1 -- Phone ------- Installation will serve: Residence [RApartment House❑ Commercial ❑Trailer Court i❑ € Motel ❑ Other -------------------------------------------- i Number of living units:----f--.----- Number of bedrooms------Garbage Grinder ------------ Lot Size -7jac-------------------- Water Supply: Public System and name ----------------- ----------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'V Silt❑ Clay ❑ Peat ❑ Sandy Loam -Ca ' Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- i (PI'ot 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,), �1 PACKAGE TREATMENT [ I SEPTIC TANK'[ ] /S,ize--- -----------------/ze ---------- ------- Liquid Depth .-----------------------._ ' .4 Capacity -------------------- Type -- --------- Material---- -----_ - No. Compartments --------- ------------ U . Distance to nearest: Well --- ------ -----------------Foion .-_ ------ Prop. Line ---.-----...._-_---_-- � LEACHING LINE [ ] No. of Lines ------------------------ h f each line--.- --- ----------- Total Length _,--------------____-------- fD' Box ------ Type Filter Ma ____________________DeF- ter Material _.__.-_________---------•-•---------------• Distance to nearest: Well ------ --------- Foundatio --.------_-------- Property Line ---.------:--___------. SEEPAGE PIT Depth -- Diamete ----------- Number - -------__-------. mock Filled Yes ❑ No ,❑[ ) PWater Table Depth --------------- --------------------_---Roe --------------------------------Distance to nearest: Well ------- --------------_-------.Fotion Prop. Line _____-...._-___._._ _REPAIR/ADDITION(Prev. Sanitation Permit# ------- ----- ---------------------- Dat -----------------------------1 Septic Tank (Specify Requirements) -------- ----------------- ---------------------------------------------------------------------- - --- --•.-•--------------------------- Disposal Field ( ecify Requirements] --------4C`G,------.---- ---- ----/�- � - -----!`-!N- ----- -------------- ,.c = -s--- !�� 5" ms_ r (Draw existing and required addition on reverse side) I hereby certify that 1 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 subject to rkman's ompensation laws of California." { Signed ----- �_- ___--.-_--- Owner B g . --� -- ----------- Title Y (lf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ='- -"ec.�==----------------------------------------- ---- DATE ��3/ --------------- - BUILDING PERMIT ISSUED ----------------------- --------------------- --------------- --------------------------------_DATE ------------------------------------------- ADDITIONALCOMMENTS ------------------------- ------------------------------------------------------------------ --------------------------•-------------- ----------------- -------------------------------------------------- --------------------------------------------------- ----------------------------------------------------------------------- - ----------------------------------------------------- -------- ----------- -----.Date ----- ��_7 P Y ------- f Final Inspection 6 6��-�--v--=------ ------------------------------------- ------------ - I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'613 Rev. 5M