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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT t � _. .........-. �...-- -..-....` (Complete in Triplicate) `..................... Permit No. .............._...... \.."..........•--_...... Date 7-5— Issued .........:......... This Permit Expires.t Year From Oat*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 made in compliance with/County Ordinance No. 549 and existing Rules and Regulations: qU� L1.1 d Y1/1.K1.�!c?�..................5T4?Ck T Q 1A.CENSUS TRACT ................... ...... JOB ADDRES5/L N ,•-�-••l-• .----�- i•/ . Owner's Name C..-..1. >).Q.�.�_Y..l..... _..I�-•l..ltl.�_kl!ld.... ......... ............. . ................. P . hone 9�,�:. .��. ......... Address .919'd.. l.(ll1Net.bY.d.......................................................... City .....5.?-4x k—T0.:4,........................................... Contractor's Name _ License # ••.•..-•--------•---. Phone ........... Installation will serve: Residence gApartment House 0 Commercial QTrailer Court 0 Motel ❑Other ............................................ p Number of living units:............ Number of bedrooms -.........Garbage Grinder ............ Lot Size ..� �� .x-°�l9•--•........... Water Supply: Public System and name ......................_....................................................Private AM Character of soil to a depth of 3 feet: Sand n Silt❑ Clay Peat Q Sandy loam O Clay Loam El Hardpan ❑ Adobe Q 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 INSTALLAFTION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) t i PACKAGE TREATMENT [ ] SEPTIC TANK Size ��'."X •-4•X!_Q.......••• liquid Depth .. . .. ............. Capacity Type ..... Material Cox ctdT-4 No. Compartments •..... .........•. Distance to nearest: Well ...-_TQ. ....................Foundation ....1.0. .......... Prop. Line J62 t � LEACHING LINE [ j No. of Lines ......./.............. Length of each .......•.•••••. Total Length ..r•..-••._-••-•-• n V:T7Box ... .. Type Filter MaArial .....(?1. k,-..Depth Filter Material ........ . ..............................V p Distance to nearest Well _520'./-..._._....• Foundation cl w .__........ .Property Line ... ................ SEEPAGE PIT [ ) Depth .... ... -... _ Diameter ......... ...... Number ............................ Rock Filled Yes [3No WaterT I D ................................................Rock Size ................................ 3 Distant t nearest• Well .......................................Foundation .................... Prop. Line .....................� REPAIR/ADDITION(Prev. Sanitation Permit# . .��• S ................... Date .................................) Septic Tank (Specify Requirements) •7,1--rel'-Z-j...............................---..............__................_.........._...... Disposal Field (Specify Requirements) ....................•••-•---------•.....---•------•----•--....-----.....-----............_...........--__....._............•-•-_•••- ..................•-r•-••-..........--•-•---••---•............---•-•-•---•-••••---•.....-••--•••---•••-••----•••--••-••-•••••--•••-•••-.......•••-•••••-•-•..........•---••--...I.:....................... :-.. .................................•---...----•-......-----...--•--•. ..� (Draw existing and required addition on reverse side) I hereby certify that 1 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 lic*n- sed agents signature certifies the following: "I certify that in the performance oft work for which this permit is issued, 1 shall not employ any person in such manner as to bec je to W a ' ompensation laws of California." Signed ..- -• ............... Owner By .................... Title ...............------............................._..................... (If other than owner) F2f DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... .. ..�.... _ •-.------•-._._. DATE . ./�... •.�..................... BUILDING PERMIT ISSUED ... z._.._..... . . ........ DTE ....... ... . ADDITIONAL COMMENTS ,tr cwwe sem-;..yQla+4tca_' c.� {�C► .:r.� •-• .................•----.................................•-•--•--......... ....................................1i ._...............---........._...............-_._-•-• ..............---- .......................................... .... ....... . ............................. -•--------•...............•-••--.............. ...... ....... . . ._' Da....---•....-•--••-•.....•-•.......... �" ........ .... ---------------- Final Inspection SAN JOAQUIN LOCAL HEALTH DISTRICT �-,�•, L3 24 1 � 7/72 3 M l E. H. - 68 Rev. 5M