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FOR OFFICE,USE """ APPLICATION FOR SANITATION PERMIT Permit No. -- ------------ ------- ----------- -------------------- (Complete in Triplicate) p� --------------------------------------- Date Issued This Permit Exp ires 1 Year From Date Issued Application is hereby made to the iSan Joaquin Local Health District for a permit to construct and install the work herein t described. This application is made in compliance with County Ordinance No. 549 and existing less and Regulations. JOB ADDRESS/LOCATION,�S��t-r��.�-----�e--o�•--- -..�y.- -- ---CENSUS TRACT ---------4��------------ JOB Phone : l� ".�`��'a`�lfa Owner's Name Y E ' Address � 4 - G ------- ------------ Cit /' . / ' E Contractor's Name ... it jC� /Y.._SP/ fic-----/• ---------------License # cS _5 -- Phone - Installation will serve. Residence Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other ---- --------- ----------------------------- Number of living units:--._1_-.-,e Number of bedrooms -,?------Garbage Grinder ------------ Lot Size _A __ - Water Supply: Public System and name ------------------------------------ - --------------------- ------------ ----- --------------------Private- Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam �~ 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,) � PACKAGE TREATMENT [ ] SEPTIC TANK'[ j Size------------------ -------- `------Liquid Depth -------------------------- �f I ----••- Capacity--------------------- Type -------------------- Mafierial-------- ----------- No. Compartments ---------=----- Distance.to nearest: Well ------------------------------------Foundation ----.--__.--- Prop. Line -------------_--- -- I ------------------- --- Length of each line-------- ------------ ------ Total Length -----------•------- LEACHING LINE [ j No. of Lines g -De Depth Filter Material -_-----------------------�--------- 'D' Box `-------__-- Type Filter Material ------------- --- p 4 Distance'to nearest: Well _------.---- ----------- Foundation ------------- ----------- Property Line SEEPAGE PIT [ ] Depth -1------------------- Diameter ---------------- Number ------a--------------------- Rock Filled Yes ❑ No Water Table Depth -------------- --------------------------------- Size -------------------------------- - Distance to nearest: Well ------------------------------------ Foundation -------------------- Prop. Line -..----.-_------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------- --------------------------- Date ----------------------- ----.---- ) I Septic Tank (Specify Requirements) ---- ------------------0. ----------- --------- ----------- ------------------------- ----------------; <.---- ------- --------=------- Disposal Field (Specify Requirements) -_- - - ------ ------------------- 4 E ------ F 100- v ----------------------- rr A *+R -Q-- ------------ --------- __ _ _e,K ------I------- �-------FirR (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: "1 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 uWect o Work n's mpensation law of California." Signed - - -a - - -- ---------------------- Owner �- ' ------ ------------------•Title -- -- --- - -------- -- ----------- --------------------------- 0 her than ow ed FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- - - ---------- ----_. DATE ..- � DATE ----------- --- --------------------------- BUILDINGPERMIT ISSUED ---------- -- ------------------------ ------------------------------------- ADDITIONAL COMMENTS --------- - --------- ---------------------------- ------------------------ --------------------- - -------------- - --- --- ----- 1 -- -----------------------------r--------------" ----------------------------------- - ------------"-------"- ----- --- ---- --- -- ---- ----------- ------ ---_ ------- --------.----.-_-- ----------- --. .-- -_.----___-___-----._-- -----""-""""--".--___-.---------""-----"---___ -.-.-_.-_- ---_------------------- -- - ." ----------- --.-.Date dFinal Inspect -- SAN JOAQUIN LOCAL. HEALTH DISTRICT C`;ZP-4k /Voles !40 r Body -V r/� .aror� r ,eewl `g9-1 .Box E. H. 9 1-'68 Rev. 5M !�°""