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ti FOR OFFICE USE: � � �• • APPLICATION FOR SANITATION PERMIT ----- -- e ski 9 (Complete in Triplicate) Permit No: ---------=-----=----------------------------------------- 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 in compliance with County QrdiUnc.e No. 549 and existing Rules and Regulations: - (JpSCsT S JOB ADDRESS/LOCATION . 2327,57----C P _ S -l------ --------------------------------CENSUS TRACT ------ -----•---------.. Owner's Name = .lK-' ---------------- Phone Address ' !!<2 _� -` P_�_IT � �lC�- CitY ------------------ ----------------------------- ------>-------- -- Contractor's Name __ - V]- ---------License # --------- ------ Phone -------------------•---------- Installation Will serve: Residence &<partment House❑ Commercial :❑Trailer Court ,❑ � Motel ❑Other ---------------------•---------------------- g g OQlJ -z Number of livin units:---I Number of bedrooms __ ______Garbs a Grinder ___� _ Lot Siie J! - v .________________________ Water Supply: Public System and name _ p l'_ ____C� Er _____sults-0_oas SN-_'___-�______ �-.-_-Private ❑ Character of soil to a depth of 3 feet: 5and' �ilt❑ k Clay ❑.Peat ElSandy,_Loa ❑ rClay.toam ❑�, Hardpan ❑ Adobe ❑ Fill Material (1f:Qt_ If yes,type ____i __________________ (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 seeps a pit permitted if public sewer is available within 200;feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ Size____ ------------ Liquid Depth ...55�--:..... W a I i Capacity /5-4)0____ Type f_R�_�!9_��_ Material��RETFNo. Compartments --.---.:--_- i Distance to nearest: Well __4_,_LAJ______________._._Foundation :___1 __- t Prop. Line �_ ----------- V LEACHING LINE [ ] No. of Lines -----_ g 4 g -- �.r----____-- Length of each line------ --- ------------- Total Length' -__-_,� __.__------ D' Box -r- t /t 14-_-- Type Filter Material __/?QC_..Depth Filter Material _______________________________ Distance to nearest: Well _____ �_ _____ Foundation _-_____/s ----------- Property SEEPAGE PIT _ line ._._..�? .....__._. - [ ] Depth _____ _ t Fill . ___ ____ Diameter ________________ Number _____.___________._________ Rock ed Yes '❑ No .❑ r_.Water.Table•bepth–_:. __, _._._�__- �_�_ _�:=Rock-Size-------------------- } ------------------- � ; i Distance to nearest: Well -------------------- -------------------Foundation -------------- _i Prop' Line -----------._:-------- REPAIRJADDITION(Prev. Sanitation, ermit.�#�--=-°--_ ;----t= ^ _ _ -=s` -- D•ate -------------------- - -1 1 F Septic Tank (Specify Requirements) ------------------- ----------------- -- ---- - ------ -----------�-----------r-:--f-F---------€-•.----------------------------- i t Disposal Field (Specify Requirements) ------ ------OF------�_E1"XH-----i_-3( -----_:-1-!- _- - - _____ -_ _ _____________ 3 __ ____________ __ -_ _ _______ ______ __ ____ - - _ _--_ _ _________________ '. i (Draw_existing-and-required addition._on-reverse_sido) J I hereby certify that I(have prepared this application and that the work will be done in accor"dance`' with San Joaquin f County Ordinances, State Laws, and Rules and Regulations of the.San Joaquin Local Health District."H cane owner or licen- b sed agents signature certifies the following: "' "I certifthat in the perfor ante. the work.for which this permit is issued, t sha'Il not employ any person in such manner as to-be a subject to o 's ; Ctp"eXn�ann laws of California." Signed - -------------------------- f Owner BYi $--------------------------= ------- -!° ------------------------------------------• Title ---------------------------------------=------•------------------ '(If other than owner) ( S c { FOR-DE'ART1V CNT-USE-'O.NLY__-_ APPLICATION �� - ---------------------� -- DATE� --+ a R`-®-- ----------------- ---------- --------- ----. ----s '. _ -- ACCEPTED BY ----- ------------ BUILDING' PERMlT'ISSUED-- - ___ "' �.�. .DATE . .~------------ w -------------------- ADDI710NAL COMMENTS -------------------------------- -------------- ----- -'-:-` ;=-�---------'---•----"-i-- ----------------- ------------------ ------------------ --- - - --=------- - ----------- - -- -- - - -- --- ecFinal Ins - --------------- -------------- -- ----Date ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M