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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------- ---- . w -- - (Complete in Triplicate) Permit No. _(1 ------------------------- -4-�]J This Permit Expires 1 Year From Date Issued Date Issued -ty7_5/:_6/ --------------------------------------------------------- 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/LOCATION4%_YS�_ __ ��G�� X -l__-- ,. -- '--- ENSUS TRACT -------------------------- Owner's Name , «a >��< -�d-----.I_X6-7 -----------------------------------------------Phone ------------------------------------ Address -` _ /�Q--------.�- --1,C7"—_'!��-----------------_ city /� License #43/c— Phoned `��4� Contractor's Name I'�...___ -- ----------------------------• Installation will serve: Residence Apartment House,❑ Commercial []Trailer Court ';❑ Motel ❑Other ----------------------------- ------------ Number of living units:-_-______ Number of bedrooms _AZ-___Garbage Grinder ________ Lot Size ____-__-_.__-______- Water Supply: Public System and name ---------------------- --------------------------------------- ------------------------------------------.-----Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑l Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material (1�- 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 f ] Size__X4 1,0----- Liquid Depth _ --------- Capacity _ Type ___ Material / ---------------l?1C/ PN . artments -/ % Distance to nearest : Well ____-- _____________________Foundati�_ _____________ Prop. line __�5../.._._._._.. LEACHING LINE [ ] No. of Lines ------1Z: Length of each line-------7-6------------- Total Length -Jo o............... J* 'D' Box ---!------- Type Filter Material _/?v-C4---Depth Filter Material ___1fil----------_....................... Distance to nearest: Well -----6-0- ------- Foundation _____f________________ Property Line __lS7__............. SEEPAGE PIT [ ] Depth __________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size ------------------------•------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ______--___________-___-_____-.--_) SepticTank (Specify Requirements) ------------------------------------------------------------------------------------------------ ------------------ ----------------------- DisposalField (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 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 become subject to Workman's Compensation laws of California." Signed -- ----------------I; --- Owner BY ------`'l" -vim--'--------------- -------------------- Title ------- (If other than own r FOR DEPARTMENT U LY APPLICATION ACCEPTED BY ----------- ----- _________. DATE _______-__ ___._ --------- -- ----- ---------------- BUILDING PERMIT ISSUED ---------------------------------------------------------- -------------- DATE ---------- -- _------------------- ADDITIONAL COMMENTS - --------- - __._.. -----------------------------11Y.`�TH__�i„ f�-'------�ho�tl _.:__� Rm_.� wA 5------ A ----------------13 W-3 - ------ - - - ------------ --- ------ -- ---------- --- --- - --- - --- ---------- ---------- --- - =_ ------------------------ --------- ------------------ -Y Inspec = -------------------------------------------------Dute -/- -- -- ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M