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FOR OFFICE USE:FI , SE APPLICATION FOR SANITATION PERMIT !� xz (Com lete in Tri licate) Permit No. P P --------- -------- - - --- ------ ----- 0 / 0 Date Issued This Permit Expires 1 Year From Date 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: JOB ADDRESS/LOC TION .__.1C_�_-_ ,CJ, -/_ `,(?05__________________---___-______-__---_--__CENSUS TRACT -------------- ............ Owner's NameToy-ems -.r-" 0----------------------------- --------------- -------------•----------------.--Phone.oWo�----74-49,5---- Address ---------' / � City Contractor's Name%_ V_ I------_45�� ,�'�!01r~Q�ense.# "4F �'��--- Phone Installation will serve: Residence JX Apartment House,0 Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------------- Number of living units:-.-/------- Number of bedrooms ._�-----Garbage Grinder _.---------- Lot Size _______________ Water Supply: Public System and name __- -_-5 e ___,__________________________________________Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ 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'[ ] Size------------------------------------------------ Liquid Depth _-__.-.____.--_---______- O Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ...................... Distance to nearest: Well ----.--------------------------.----Foundation ---------------------- Prop. Line ----------_--------- LEACHING _-•___-.- _._.-•.LEACHING LINE [ ] No. of Lines _-_ ------------------- Length of each line------------_.._. --------- Total Length .--------------------------- 'D' Box .--------- Type Filter Material ____________________Depth Filter Material --------------------._..__..............._.._ Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ----------------- ...... SEEPAGE PIT [ ] Depth ___-__ ------------ Diameter ________________ Number ---------------------------- Rock Filled Yes '❑ No i❑ WaterTable Depth ----------------------------------- ------------Rock Size --------------•----------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) Septic Tank (Specify Requirements) ---------------- ------------------------------------�--/-------------------- ------------------------------.-------- -------------- D' posal Field (Specify Requirements) , 1P/�2`/ J----------'`Y _�/q/_'; .__. .__._Q ___,L G ______________ 4 'I .LC1/ -------------- X � „ �/ G•Q /;irC_�fGl.r�i,,! ---------------------------------------------------------------------------------------------------------------------------------------------- (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: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to bec sub)e t to pensatron laws of California." Signec�M. 2 .�0'�- ------------------ --------------------- Owner BY ---------------------------------------------------------------------------------------------------- Title -------------------- ----------- ------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE d -------------- BUILDING PERMIT ISSUED _ _- _-_-.__-__- --------------DATE _-_---__-- ADDITIONAL COMMENTS ___ _ _ _ -__._ ._. - ----- - - ---------------- -------------------------- ---- j - ----------- --------------------------------------------- - -- ` - 'Final Inspection by: ------------- ---------------------------------------- -------•--------------------------------------------------.Dater SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M //