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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .. Permit No. _�_._�- -�--•-� ------ _ - - - (Complete in Triplicate) ' ---- ---�-- ---------- ----- -- ------ Date Issued ` This Permi ---- t 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" in ccomplian5a wii h^County Ordinance No. 5.49 and existing Rules and Regulations: < /V: SUS TRACT --------------•----------- JOB ADDRESS/LOCATION �..... -/V �" f / >--------- ---------Rhone Owner's Name ----��/� 'S'------------- /�. I ,e. j-�.- "_"`.- ------------------------ City _. G�i/t.-�d ----------- :------ ------�--.- Address ��-- ---- ""�-""-""- r 64 ` > Contractor's Name -"-. License # ��o& Phone --- "-- ---- - Installation will serve: Residence R<partment House❑ Commercial:❑Trailer Court ❑ Motel ❑Other ----------------------------- If;----------- 1 - _.r`r��!?---- - - '�� Number of living units:---- Number of bedrooms _ __--Garba.ge Grinder Lot Size XC- - Water Supply: Public System and name ------------------------------------------------------------------------ - - - --- --- -- - - Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑f+ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ !_ e --------- ----------------- Hardpan ❑ Adobe'X 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 ermined if public sewer is available within 200 feet,) �(y p p � r Size_ !. �Q----------------- --- Liquid Depth ---------------- PACKAGE TREATMENT { ] SEPTIC TANK. --Y T ereL,( T- Material_ - -s------ No. Compartments --- '----•---- ---- Distance �YQ- - yp , Distance to nearest: Well y®---------------------------Foundation .___ '4_ --_____ Prop. Line __ -- ---------- 19 ---------- - Total Length -X-4W-------------- LEACHINGLINE � No. of Lines ______________ ___ _"_-- Length of each line____ __ _- - �� D' Box v -" Type Filter Mater`a/. —.0 �©epth Filter�Material __ -------•--- o ! I Foundation -Zai - --------- -- Property Line .- --------- Distance to nearest: Well ___ ___ __________F�" SEEPAGE PIT [� Depth _dam ---------i �Diameter - - ------ Number ----- ---------- -- Rock.Filled Yes ,� No l� — '�-�-••----- , Wafter Table Depth -------- 9-1- ------------------ Rock Size ll R Distance to nearest: We ___ C2- ----- ' FoundationQ----------• Prop. Line __ ±J--•----• ` REPAIR/ADDITION(Prev. Sanitation Permit# -______-.___---_-.---- - --"`Date ------------------------------ ) Septic Tank (Specify Requirements) ------------------------------------------------------------ ---------------- l Disposal Field {Specify Requirements] -------------------------------- ------------- " - ----------------------------------------------- ------------------------------_--------_------------------------------------------------------------------------------------- i _ _ _____________________I__ _______________________ ________ ______________________ -------------------------------------------------.----------------------------- _ __ __________ ________ _ • {Draw_ existing_ and required addition on reverse side) I hereby certify that l 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- i sed agents signature certifies the following: i "I certify that in the performance of the work far which this permit is issued, I shall not employ any person. in such manner as to become subject to Workman's Compensation laws of California." ---- - Owner M -- -------- ---------------------------------------------- k Signed ---- ----------- -- . . . . -Title ' By ....... -- --------------------- ---- -- -- -- - -- (lf other than owner) FOR .DEPARTMENT USE ONLY ' DATE `- = 7f-�J ^------- APPLICATION ACCEPTED BY ---- --- --r------- - -----------"------ ---tDA - --------- ----------- --------------- BUILDING PERMIT ISSUED -------- -- -- _ ADDITIONAL COMMEN 5 -.,r'� if�'` - ------- ---- mac_ -------------------------------------------------------------- ------- `J -------- - -- - r -- ------' •--- - - --- --- ------------------ --- --- --- ------- ---- --- -------- ----.Date --------- --------�-1�-• -- -------'--- -- I Final Inspection by: �- -� - - - --- --'---"" - - SAN JOAQUIN CAL HEALTH D STRI T E. H. 9 1-'6B Rev. 5M,