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FOR OFFICE VSE: h .- t APPLICATION FOR SANITATION PERMIT w ---------------- - ------- ----------- ------------------ Permit N : . o:m (Complete in Triplicate) _ ---_-------_-----------------------_------------- Date IssuedThis Permit Expires 1 Year From bate Issued I ' Application is hereby made to the San Joaquin Local Health District,fora 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 .-_�-*3a — ----- D-� S it _:-: --T.--, -MT - ---------_CENSUS TRACT ._---�0-----•---------- aL - N N-`"-T T------------------------------------------------------------ Owner's Name ------------ - - � Phone Address -------------`3 ------- p-1 �-------------------------!A----•--. City ----�/' � ! Contractor's Name -T fl'- -- -------------------------------------------- ------------=-------.License# ---------.-------------- Prone ------------------•--..... Installation will serve:` Residence apartment House,0 Commercial []Trailer Court ;❑ a X", i Motel ❑Other -------------------------------------------- Number of living units:___ _; Number of bedrooms _j;Z=.Garbage Grinder NC7---- Lot Size A24-,04 D -r Water Supply: Public System .and name -------------- ----------------------------------------------------------------------------------------------Private ❑ F � Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam '❑ .�.rm hardpan ❑ Adobe ❑' Fill Materia) ......:1f-yes,-type- --------- -'- �- .- i (Plot plan, showing-sizepofilo ocation of system in relation to wells buildings, etc. must be placed bn reverse side.) (,1! NEW lNS ALLATIbN: {No septic tank or seepage pit permitted if public sewer is available_within 200 feet,) Q .,_ J-j PACKAGE TREATMENTSEPTIC TANK ' [ ] I [ ] Size---- - ------------------------------- Liquid Depths N capacity ---- ---;-- Type 1 _ Material---------------------- No. Compartments Distance to 1nearest: Well --------- ---------------•___--Foundation ---------------------- Prop. Line .----_•--- ..:__..._ y LEACHING LINE [ J No. of Lines ___.___.__--- L6 gth-of each line_. _ __ Total Length ____________________________ 'D' Box ------ Type Filter Material ____________________Depthl, Filter Material ---------------- Distance to nearest. Well ____________�" _ Foundation __ _.__________________ Property line -- _ _ ---------------- SEEPAGE PIT [ ] Depth _#----------------- Diameter____________ -�- _I- ___-__ Rock Filled ,Yes © No 0 �, I } c--------------------------------NumbeRock Size -------------------------------- Distance ------------------------ Water Table Depth ------------ ---i $ i� Distance to nearest: Well -------- ----------------------Foundation -------------------- Prop. Line ..__...._...__... p `• -,,- � Date ---------------------------------- REPAIR/ADDITION(Prev. Sanitation Permit# _ -/. ' '------------------= Septic Tank (Specify Requirements) ----- �qT ,P------RgUMw—OD------5F--_PT1 lam-,'..--"Tt 6NK--- NMH Disposal Field (Specify Requirements) �/..�a�___�R�_=!_CQ�C�:.____Pfir_`_�R13-____��PTC�._'"7=iA1!�YK_�_-•__DIST s ; ; ---- ------------------------------------ --- - ' existing ci d`equi'red ad-hOtibn on reverse side} I hereby certify that I have prepardd`this application"alnd that the,work will be done in accordance with.San Joaquin County O'r'dinances, State Laws, and Rules and Regulations of the Sb R'Joaquin Local Health District. Home owner or licen- sed agents signature certifies tfie&6l ving: "1 certify that in the perfarmgnce�`of the workfor-'which this permitis issued,,I shall not employ any person in such manner as to become ject to rkman's Compensation'laws of California.' i Signed _ ._ , -- ------------------------------ Owner By ------------------------------------------ A I- ,f------ -=--------------------'---------- Title -------- --------------------------------------------------------------- (If other than owner(_. , °r f FOR DEPARTMENT USE ONLY ON BUL DINGl-PERMIT C ISSUEDDBY__= _ _ _ .�-Q�- T= = = _ ._______ - - - ' DATE -.-----.S--L�`.�� ----------- BUILDING ---------- ADDITIONAL COMMENTS - -- - _DATE ---------------------- --- ---- ------ - ------------------------- ------------------------- --------------------- -------------- -- - ----------------- - - - _--------------------------- ------ ------------------------------------ -- ------------------- - -- ------ - -------------------- - ---------------------------------------------------------------------------------- - — - -------------- f .r_ Final Ins -- ----------- -----------Date - ------ --- � -I---------- --------------------------------- JOAQUIN LOCAL WEALTH DISTRICT E. H. 9 1-'68 Rev. 5M