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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.4/11.��'�--�' ----------------------------- ------ - (Complete in Triplicate) --- ( °------- Date issued _��. --------- - �� _�•1 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 applicaticin is made in compliance with County Ordinance' No. 549 and existing Rules and Regulations: + ZZW ---------------------------CENSUS TRACT -------------- ----------- JOB ADDRESS/LOCATION.----�-/ -------------" " _ Phone " � -a 3� Name : j�yG �� ; Gam, ------------- Owner's ------------'------------ ----------------------------- Address �' City ---------------------�-------•------ ------ --=--- --- --- - ------ �/ 3 Phone ' �/�yoZ Contractor's Name ------- Q:< License Installation will serve: Residence %Apartment House[] Commercial ❑Trailer Court ;❑ Motel ❑Other _-.__.. / lQ --------------------- -- - 14 Number of Living units:----- ------ Number of bedrooms ---- ....Garbage Grinder ------------ Lot Size --- -_[o_----" ---- ----------- Water Supply: Public System and name -----------------"---__-_-.---------.---------- --.--.--_-PrivateX Character of soil to deiDth 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 [ I SEPTIC TANK [ ] Size------------------------------------------ ---- Liquid Depth . Ca acit - Type -------------------- Material.--------------------- No. Compartments --------------•--•---- 0 Distance to nearest: Well ------------------------------------Foundation --_-_ .__------ Prop. Line ---------------------- ... ... _ Total Length -------- LEACHING LINE [ ) No. of Lines _______________"---._-,Length of each line__---------------"-._ 9 'D' Box ------------ Type Fater Material --------------------Depth Filter Material --.---.---------..--------------------•----•- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------------------ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ------------------.--------- Rock Filled Yes C] No 0 WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -""-._._.--------------------- ) Septic Tank (Specify RequiYements ___-___.- "` ------- ------------------------------------ -------- ----------- •. ---------- ---•----------- Disposal Field (Specify Requirem}nts) D _..-. r -f -�--,,-/- k ------------------------------------------q---- -------------------- - ------ ------------------ ---------------------- ----------- - -----------------------------'-••---------------•---- ��y(� %J, r --- - "--------" -- (Dr existi g 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, I shall not employ any person in such manner as to become subject to Work 's Com ens on laws of California." �/f t ---------- Signed -�Comp Owner --- -- ------ � J BY ---------------------------------- Lam_ `�' Title ------------------------------------------- ------ ---------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ,101 1111111111111, 00 =-------------------------------- ---------- DATE ---,�2--Z _-fir---- ------------- BUILDINGPERMIT ISSUED ------- -- -------------- ------•----------------------------------------------------------------- DATE ADDITIONAL COMMENTS -----._----.-_----_`------------------------------ --------------------------------------------------------------- ------------- r /:2: f� lg Y"' P`s" ------s.. • Date Final'Inspection by: ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M p