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- FOA OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- ------------------- -- (Complete in Triplicate) Permit No: - --------- �7� --------------- -------------- Application -- - __ This Permit Expires 1 Year From Date Issued Date Issued '._F`-.--,.:-__ _. �v.1 _ •------------- 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/LOCATIO ------------------ ------------/-TU- - ..----- -'RD----------------------CENSUS TRACT _�_Sl..--.-_--. Owner's Name ----------- VQ�N-------C®7_-R1-1-—------------------------------------------------------------ Address --------------------------------- �lty ----------------------------- --- -- - -- ------ ----------------- Contractor's Name M�1R , 44VACe__- - ----------- _-._� ` 'a /_! '-_ icense # 5 �.!___- one�Q_ Installation will serve: Residence partment House❑ Commercial [-]Trailer Court I❑ Motel ❑( Other------------------------------------------- A , i�C_ _ Number of living units:__-- ------ Number of bedrooms :-3_- _.-.Garbage Grinder/i�5. Lot Size /c 6 -.-_------------- Water Supply: Public System and name ------------ Private Character Lt' of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat Sandy Loam ❑ Clay Loam;❑ Hardpan ❑ Adobe ❑ NIT/Material __ __-__--- (ryes,type --------I---------------- -(PIot 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 seepa pit permitted if ublic sewer is available within 2.00 feet,) t r PACKAGE TREATMENT [ ] SEPTIC TANK � Size---- Liquid Depth _-_ ---------------- Capacity/;279C7---- -----.--- ----.Capacity/;2-007.,-_ Type Pfi� _Material._60N�o.� Compartments ............ `4 stance to nearest: Well -------�-_' _--_Foundation ----- - Prop. Line LEACHING LINE !�] No. of Lines ___-�---.-.____-- Length of each -lime--- Total Length` ............ k D' Box��SType Filter MaterialRQ-4K'---Depth /Filter- Material ___„1- .'_______________1........-_.. Distance to nearest: Well ._-J�__'—I, Foundation -_- Property Line _S..__ '....... SEEPAGE PIT [ ] Depth ----`- Diameter --------- Number ------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size ------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITIQIS(Prev. Sanitation Permit#--------------------------------------------- Date -------- ------------------------ Septic - --------------------Septic Tank (Specify Requirements) ----- -------- ---------------------------1--------------------------- Disposal .-------------------------------- Disposal Field (Specify Requirements) -.------_--- ------=--='---------------------------------------------------- ------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw ------ -----------------------------------------------------------------------•------------------------------------------------..-_----------- (Draw existing and required addition on reverse side) I hereby certify that I hpve 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 Wo4tman's Compensation laws of California.” Signed ------------------ ------------------------------------------------------------------------------------ Owner Byk ----- -- - - ---- - -------------------------------------------------------- Title ----------------- ------------------ -------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -7---_1-_-�R---a--------------------------------------------------------------------------- DATE ----- -- `�4—,;:7---Z BUILDING PERMIT ISSUED ----------------------------------------------------------------------------------------------------- ----DATE ------------------------------------------- ADDITIONAL COMMENTS - ----- ------ ------------------------- - ---------- ------ -------------- ---------------------- ---------- --- ---------------- --- --- ----------------------------------------------- ---------------------------------------- ------------- ------ ---------------- ----- - - -- --------- ------ -- ---- --------- ---------- 3 ; Final Inspection _--Date ----- SAN -.SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M