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FOR OFFICE USE: f. -So APPLICATION FOR SANITATION PERMIT <<'�' ` (Complete in Triplicate) Permit No: _A------ --------------- This Permit Expires 1 Year From Date Issued ��( Date Issued .-�___."_7v 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 �m/ade in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ? ----,�----,��/Y� ( -------------------------------------------------CENSUS TRACT ------_--_ Owner's Name ----7QlVX---------/•��Z�r�i2------------------------------------------------ ------ Phone --------------------- - ------------ Address ----------/J.X`-g'-��------------A� ---------------------- City ----- 2"71 c' ------------------------------------ Contractor's Name5--.---.57,,/_ ,� ----- G :__-_.License# Phone j�� ----:5;�2_24 Installation will serve: Residence JRJ Apartment House❑ Commercial ❑Trailer Court Motel ❑Other------------------------------------------- Number of living units:_____ Number of bedrooms ..___Garbage Grinder /"_c?__ Lot Size __ ____ _ 1 ' -_--------------- 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 ❑ AdobeV 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_ _r %1' .�'_.;�-_�_-�_,___ Liquid Depth ___-rte__ -------- .......... Capacity woe Type ;- V!77_-_ Material -21V00 No. Compartments .............. Distance to nearest: Well __/_(,!52_'_________________Foundation ___!rd__C_-.-____ Prop. line LEACHING LINE D4 No. of Lines -----l---------------- Length of each line---- 0-GJ- � .�_________ Total Length ,�-l•'-!J___!_......_.._ 'D' Box _ !� ��__ Type Filter Material Filter Material __.��................................. Distance to nearest: Well 'L ------------ Foundation ------------ Property Line �~-`............. SEEPAGE PIT b4 Depth ,�._ 6 �� 0 ._ '____._ Diameter ___ ___.___. Number ______ ____________________ Rock Filled YesGj�j• No ? �e Water Table Depth _-c�-Vie_--____________________________Rock Size _ � �_________.___ Distance to nearest: Well _1G7 '-----------------_......Foundation Prop. Line.........__.. REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- --------------------------- 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 Son 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, I shall not employ any person in such manner as to become subject to Wor an's Compensation laws of California." Signed -----. Owner BY -------------------------------------------------------------- --------------------------- Title ----------------------------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY ^^� APPLICATION ACCEPTED BY DATE --,J�^'�-2�`� 1 BUILDING PERMIT ISSUED -------------------------------u� -------------- - - - ------- --- - --DATE ADDITIONAL COMMENTS ---------------- ----------------- - - ------------- ---------------------------- ----- ----------------------------- -------------------------------------- --- --_Y � � :----- ---- ---- -- - - - ----- --- --- ------------------------------------------------------------ __ __ __ -------- Final Inspection b JOAQUIN J F P Y --------------------------------------------------- Date . (} ----- L�� LOCAL HEALTH DISTRICT r1 E. H. 9 1 rrAA``l�Rev. 5M