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FOR OFFICE USE: ' --------------------------------------------------------- APPLICATION FOR SANITATI6N PERMIT' Permit No. ---7-�-"---7-5-r ! (Complete in Triplicate) ------- ---------- This Permit Expires 1 Year From Date Issued Date Issued --- 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 and existing Rules and Regulations: JOB ADDRESS/LOCATION .---/� _. __CFS-- ------------------------------------=----------.-----CENSUS TRACT -------------------------- Owner's Name Q � J�1G[3/t�,1 N M .................... Phone -0� 1 Address ` -d -----------�--------- � `, � City ---°- -�-?. -117 -C�-------------------------------------------- Contractor's Name ----- - --li- - ---e/a.Z /. ---------------------=--------License # 91 _ Phone � '" Installation will serve: Residence X Apartment House,F Commercial:❑Trailet Court ;❑ Motel ❑Other-------------------------------------------- Number of living units:___________ Number of bedrooms --�-.Garbage Grinder ___________ Lot Size ___________________________________________ Water Supply: Public System and name -------------------------- ----------------------------------------•------------------------------------------Private 5 Character of soil to a depth of 3 feet. Sand'25 Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ I Hardpano- Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot __________________________(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,) PACKAGE TREATMENT [ J SEPTIC /WeF '[ ] Size- --------------------------------------------- Liquid Depth ------------------------- Capacity ------ ------ Type -------------- ----- Material---------------------- No. Compartments ---------------------- b Distance to st: 'Well ---------- ------------------------Foundation ---------------------- Prop. Line ----------------------- LEACHING ------.-- _--------- d'I Total Length �( RING LINE [ ] No. of dines ------------------------ Le gth of each line------ ---------- - - 9 ---------------------------- `�l� D' Box _______ ype Filter aterial ____________________Depth Filter Material _- Distance.to nt: Well ___________ ___ ___ Foundation Property Line __________________._____ SEEPAGE PIT [ ] Depth __________ ___ Di eter _---____-____ Number ________________________ )tock Filled Yes ❑ NoQ WaterTable h - ---------------------------------------------Rock Size ------------------------------ Distance to nt ell _--------------------------------------Foundation -------------- ---- Prop. Line _____...__......._..__ REPAIR/ADDITION(Prey. Sanitation P # -------------------------------------------- Date -------------- -----'Septic Tank (Specify Requirements} ----------------- -- ----------------------------------------------- ------------- --•<• •-------- Disposal Field (Specify Requirements] - ---------------------------------------------- r dc�` �/ x,mr 1 �o d f - t�----------------------- ' r-�fiv ----------3---& - ----- , (Draw existing and required add' i 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. Dome 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 orkman's mpensati.on laws of California." y Signed = --------- Owner r ,! r { Title ------------------------------------------------------------------------ If other than owner] . I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- - --------------- --------_--_-------_------. DATE BUILDING PERMIT ISSUED -------------------------------------------------------------------=------ .......-r.................---.-DATE ------------------------------------------- ADDITIONAL COMMENTS ------------------------------------------------------------------------------------------------------'---------------------------- --------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- ----------- --------- ---------- ------------------ - ----------------=------------ Final Inspection by: �.- -------.Date ---Z:-;gso' >C5Q SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �1