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fOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------"---- '° ----------1 t-3 .� .� _ , r �" Permit No -----------=----- (Complete in Triplicate) S�� - --------=----------------------------------------------- ------------------______-----------------_--------------- This Permit Expires 1 Year From Date Issued 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 madeincompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . -- o`----�ha�_Kp.----------------- ------------ ----CENSUS TRACT -------------- •----------� Owner's Name -C_�_ ��_ - ( ��L ------------------------------------------------ -------------------Phone 1.6_�I- / Address .__ -------- ro--_. --,e� -------------------------•--- City -----�fQ__CA_7'OV)-----------------------------• -•--•-- Contractor's Name _-- -j4-0',I(O-.e,� an__R*_0,0>__.License # ___ Phone Installation will serve: Residence Apartment House-[] Commercial :❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:-----/____ Number of bedrooms ----Garbage Grinder --A/O-- Lot Size _r_0 17,fIZ116011Yo Water Supply: Public System and name ----------- .1 a�G-------- _ -S--fQ�_---------------------------------------- ------Private E]Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Cj 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,) V1% PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-------------_---------------------_------------ Liquid Depth ______________-.-------__ Capacity -------------------- Type -------------------- Material.-------------------- No. Compartments Distance to nearest: Well -----------_------------------------Foundation ---------------------- Prop. Line ___-___-_•--:__-_____ LEACHING LINE [ No. of Lines __ � -- ----_. Length of each line-----A"d Total Length _---_/ ________-_ 'D' Box ----,�___ Type Filter Material __ � _� epth Filter Material _______��_��______________________ Distance to nearest: Well __Ak14 ______ Foundation _______________ Property Line --_ SEEPAGE PIT [y}� 'De th �. � Diameter"_ `� _______ Rock Filled Yes ®�No i❑ 1 -'-,Diameter'----, ------ Number - ----------- : Water Table Depth ---------I&--------------------------------Rock Size ---,---------------------•---- Distance to nearest-yell ---- __AQWM -_--_-._--_-____Foundation _-lad______---- Prop. Line ___ ___________ REPAIR/ADDITION Prev. Sanitation Permit# _______-.__/YD___________________________ Date _-________________-.__..__. _l__) Septic Tank (Specify Requirements) ------------------- --- = • -- Disposal Field (Specify Requirements) _ f ___ ____ _ }� � ----- � , -----------w ----------------------------- ---------------- --------- ________ ► (Draw existing-and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done Waccordance 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 blect to Workman's Compensation laws of California." Signed - ----------------------------------------- Ow i BY ---------- ------------- -------------------------------=----------------------------- ----y----------- Title ------------------------- --------------------------------------- (If other than owner) FOR DEPAt T—M NT -USE OtgLY DATE --- �� APPLICATION ACCEPTED -----,-------- DATE BUILDING PERMIT ISSUED -- ----- -- ------- ,: n ADDITIONAL COMMENTS ______________________________________ " •- _ . ---------------------- ---------------------- --------------------------------------------- -----------------------------------------------•- z. - Final Inspection b ------;Date.--- -_"-- -- -- -- ---- - --- t SAN JOAQUIN LOCAL HEALTH DISTRICT, E. H. 9 1-'68 Rev. SM ,��