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r FOR OFFICE USE: 1F APS. CATION FOR SANITATION PERMIT ----------------------------- ----------------- a - - Permit No. (Complete in Triplicate) Date Issued _!_-k--09 _______ --------------------------------- This Permit Expires 1 Year From Date Issued r Application is hereby made to the San Joaquin Local Health District for a permit to construct a 'n II the work herein described. This application is made in coin liance with Cou ty Ordinan No. 549 and exisfiyla es and Regulations: �d �5C t�WN �R�rf� JOB ADDRESS/LOCATION ---C SUS TRACT ------------ ------------- Owner's Name E# LI t V1Ca_S_t,41 C' --------------------------------------- -------Phone ------- V1'L ------------- Address0- 1? y VYl-ttlC D1 City ----------------------------------------------------------------------•---•-- I Contractor's Name Y► ��- ----- -------------License # ------- ---------------- Phone ------------------ Installation will serve: -• Residencl�Apartment House❑ Commercial ❑Trailer Court [] Motel,❑7Other ----------------------------------- ' Number of living units:____ ______ Number of bedrooms -----.-----Garbage Grinder ------------ Lot Size ------ -------------- ---------- Water Supply: Public System and name -----------------------------------------------------------------------------------------------------•---------Private Character of soil to a depth of 3 feet: §arid'❑, Silt C] . Clay E] . Peat E]- Sandy Loam E] Clay,Loam ' d Hardpan ❑ 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,) ay PACKAGE TREATMENT [ ] SEPTIC TANK![ ] Size---- /__ .... . Liquid Depth ' ___ _ -------- Capacity ____-__ Ca acity -- Type ________________---- Material___ OAQ0No. Com ✓ Distance .._-.__ to nearest: Well ----------_J- -------------------Foundation;-------1-U__------ Prop. Line ----------.�----•.-- LEACHING LINE [ ] No. of Lines ----------- ----------- Length of each line.......... -------------- Total Length _____.. _-__________-- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ----------- -------------------------------- Distance to nearest: Well --------so- -----_so_i_______ Foundation ----- _P__._________ Property Line -------_________________ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------. Number --------- ---------- Rock Filled Yes ❑ No .Q Water. Table Depth ---------------------------- ------------------ Rock Size ---------------------------•---- Distance to nearest: Well ________________________________________Foundation :-------------- ,Prop. Line ____.---_-.-_________- REPAIR/ADDITION(Prey. Sanitation Permit# ------ "- --_y�_�______________ Date ----- ------ SepticTank (Specify Requirements) --------------------------------------- ------------------------------------------- --------- -----------------•--------------------------- Disposal Field (Specify Requirements) ------------------------------ -----------•:-------------------------------------------------------------------------------------=--- -------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition 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. Home owner or licen- sed agents signature certifies the following: F "! 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 o Workman's Compensation laws of California." Signed ` �' ---- -----------I Owner By ----------------------------------------------------------.-------------------------------=------------- Title -------------------------- -------------- ------------------ (If other than owner) FOR .DEPARTMENT USE ONLY E, APPLICATION ACCEPTED B ------ ------------------------------------------------------------ DATE ------1- -------------- BUILDING PERMIT ISSUED . ---------------------------------------- --=--------------DATE ---------------------------- --- ADDITIONA COM ENTS ---------t- --- - ----------------- ---- ----- ---------- � n� ks :sl5- lea-.-----be��NSW _ c � G + • -------------------------------------------0--------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- --- - -- ------- --------------------------------------------------------------------------------------=---- ------ ----- ----- --- - -- Final Inspection by: --__ ----------------------------------------Date ---- - '-� �-------- .. -_---- ---- ------ ---- ----------------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M a.