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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ► Permit No: : (complete-in Triplicate) �; ---------- -------------------•- ---------------------- v Date Issued ZJ y-_7 L. ' I! This Permit Expires I 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 in compliance with.County Ordinance No. 549 a d existing Rules and Regulations: JOS ADDRE5S/LO .A EON ---•-_ G�F :'CENSUS'TRACT --------- --- •-• ------- ibil ;OFF �: _._ phone i Owner's Name / / 41.e t ----- R Address _�� - - - - '------_ �_ _xxaC�. --s: . ., "----'---------_-----------•------ trs . f Contractor's Name ZAP... ��f_A_,':--- ---�.:a`,�-- -� --------=-=--------License # �r ,�_.��__.....Phone L 1it�1 i e Installation will serve: RI esidenceN Apartment House,i] rCommercial :❑Trailer Court ;❑ Motel ❑ Other ------------ ------------------------------- Number of living units:-----1'___ Number of bedrooms--.--Garbage Grinder Lot Size -- --___ ---------------- Water Supply: Public System and'Iname _ --------------------------------- -------------------•--------------------•--------=: Private --------------------- Character of soil to a depth of 3 fe`et:--Sand'❑ 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,) l --- a /�6__ =6�-------- Liquid Depth ------------ �1 PACKAGE TREATMENT [ ] SEP71C TANK'[ ] � S - - -- - Capacity__16&0 Type 00-PV __'�Material__i�lJ/�_�_r-- No. Compartments )l Distancel�to nearest: Well ---- d _ _____________Foundation ___/ia_____ - -- Prop. Line4- LEACHING LINE [ ] No. of Limes ---- ---------------- Length of each line- 7n-6-0 Total Lengtl ____o�_�d_----_____..- 'D' Box ----- Type Filter Material ____� IC---Depth Filter Material ___________________________ �- Distancetonearest: Well ------- -----",Foundation ____ ----------- Property Line _ _______________ [ 1 p ----------------- Dia meter --- ------------ Number ----------------------;----- Rock Filled Yes 0 No 0SEEPAGE PIT Depth Water Table Depth -----I------------------ .---- ;----------Rock Size -------------------------------- Distance`to nearest: Well ____ __________ ------- .-Foundation -------------------- Prop.:Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ---- ---------------------------------- ------ Date -------------- ------------------- l ) Pt ents) ------------------------ - - ------------------------------------------------------------------------- Disposal eq --------------------------- j------------------------------------------------------------------------------ (Specify Field (Specify Requirements)Reui ----------------------------------------------------IIl---------------------------------------------------------------------------'- --------------------------- I ---------------------------------------- � ------------------ ------------------------------------------------------------------------ ---------------------------------------=- --J--- 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,hand.Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the i`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 Workmdrt's Compensation laws of California." r Signed . I� --------------- Owner BY - ' (If other than owner) o F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... _/G ~ --------- ----- - ---------------------------------------- -----------------------------� DATE - - --------------- --- BUILDINGPERMIT ISSUED ---------I--------------------------------------------------------------------- ---------------------------DATE ---------------------------- -------------- ADDITIONAL COMMENTS ii_--- ___. -------------------- ------------------------------------------- -------i ------------------------------------------------------------ I ---------------------- ------------------ ----------- --- -L--------------------------- --- --------- -------------------------------------------------------- - - Final Inspection by: -------- - � {rC - Date -- ---------j-- r��------------- SAN ---- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M ��