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t FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT •�� ......................................... Permit No. �/..�1:."11;5 (Complete In-Triplicdte) p .. ....................................... This Permit Expires 1 Year From bate Issued Date Issued J9=1?' ..:. :.7:. 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 mods`In compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESSJLOCATiON ..... f............................... ...................CENSUS TRACT .......----- :.. Owner's Name .. , .:.. .H/4.. 1.. -- ---...... —........... ...... ...................:.....................Phone Address !f/ ................................•..----------. ............ •--........ City .....6/:'_V.4:5�et Q ...... ................. Contractor's Name .........................................................................`....----•-----.License #/ � cT Phone t 9 Installation will serve: Residence MrApartment House❑ Commerclal []Trailer Court ❑ ` Motel ❑Other Number of living units------f-.... Number of.l edrooms .3.....Garbage Grinder NO.... Lot Size .rI�IX1��-r.................. Water Supply: Public System and name g. _. ' ......_Private ❑ + .. -.. ._ Priv t Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ peat❑ Sandy Loam [] Cloy Loam;❑ Hardpan ❑ AdobeW Fill Material ............ If yes,type _---_------------------- (Plot --- _ --------..-----:(plot plan, showing size of lot, location of. system in relation oto wells, buildings, etc. must be placed ont•reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK T ] Size:'.............................................. liquid Depth ............... }� Capacity ...............----- type ..................... Material......----......--.... No. Compartments :.....................-- Distance to nearest: Well .....................................Foundation _..:................. Prop. Line LEACHING LINE [ ] No. of Lines .._.--..._..`...__..-._ Length of each line-------------------_--- .... Total Length ....:....._... ............. D"Box :..Type;.Filter, aterial - er. _ .. ..............Depth Fil Materia --•--...........---- -----.....----..... = Distance to nearest: Well ............... -.•-..... Foundation ....--••---.. ......... Property Line :.................:..:.. SEEPAGE PIT O Depth .................... Diameter ... ............ Number ...............:............ Rock Filled Yes-❑ No ❑ { Water Table Depth ...............................:.::.............Rock Size ........................... Distance to nearest.• Well ...Foundation Prop. Cme` --=----------- REPAIR/ADDITION(Prev. Sanitation Permit# ...'..:........... --•--•------. i............ Date ................................ .) - SepticTank (Specify Requirements) ------•--•-......... ------ •-------------•- .....--.............._....-•-----. :.. ....................................._...::.._......... Disposal Field (Specify Requirements) .._✓. LI.: :._ / � -..., /./ �:...,•.... 1✓ -.-.-.-...T,GvP._.._-.--".0,17— nr k ....................... -----•---- ................................... ...............................-..............................:-............................................................ (Draw existing and required addition on reverse side) *- '" -�..-.-R-. 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.`H-cme dwner 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 os to become subiect to Workman's Compe cation laws of California." Signed ...... ...................... ----•----•--•---•------- ------ - -------- ' _. Owner By .........................••----........----...-------- . •--•--.... � ................-- - - ----------------i-- Title ...-.:��---- --.-...-. ..:....----="�-�.,, ' (If other than owner) ~ FO PAIRTMENJ USE ONLY APPLICATION ACCEPTED BY . .. . ..... ..., ................. DATE... ---- BUILDING PERMIT ISSUED ....................................=-- -----------•---•- :`..................----......._....... .DATE ADDITIONAL COMMENTS .................... .....................• •-•................. ............. -------- ..................... .............................................. ............................................................ .:................... ................................................................................. .......... ..................................... .. ... ... Final Inspection by: . f" .......... .......:Date . � . ...-... ........... ......... . SAN JOA IN LOCAL'HEALTH DISTRICT x5 � F 14 13 24 1.'AR tau 5M v � .� 7/723m