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i FOR OFFICE USE: 4, `APPLICATION FOR SANITATION PERMIT ' J ` --- I ---Y------ ` ----------- -9 :�o - ----- -- - - j -� - Permit No. ..7��:-----�-_ (Complete in Triplicate) . ------ --------1 / "'A Date Issued .___-._-.__________ __________________ This Permit Expires 1 Year From Date Issued Applicationis 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 wi County Ordinance No. 549 and existing Rules and Regulations: I JOB ADDRE ---- ` SS/LOCATION - ��a1Q CENSUS A T 1 Owner's Name - ,L��------C/ = � Phoned�Z r 1�.l fn........ City -- --------------------------------------- I Contractor'sIName ------------ --------- - --------- ----.License#10-J-x'14----- Phone�'I✓b.b_-_G_44.7 Installation;will serve: Residence ❑Apartment House,❑ Commercial ❑Trailer.Court ❑ ,. .�. 1�_, ______PMotel.Q_Other-.- l � Number of living units:___ ___- Number of bedrooms _ rb�SGL.7(,i�neC ___ Lot Size 16-42-__K- 1__®_---..___- _.Wate Su Ippy: Public Sys em and name - ----- - ----- .----- - ------------------------i ------------------------Private❑ Character of soil to a depth of43`,feet Aand'❑ Silt❑ Clay .❑ Pea't�❑ *Bundy Loam ❑ Clay Loam 0 Hardpan ❑ AdoV be Fill Material ------ - If yes, i,type __._lj---- ----- ------ --- fl Ik t Nk (Plotsize-of-lot-, location-of c 1 plan, 'showing size�of�lot;location-of system in relation to wehl`s, buildings, etc. n st be placed on reverse side.) NEW 1NSTALLATION: (No septic tank or seepage pit permitted if public sewer iVvailabletiwithin 200 feet,) iACKAGE TREATMENT [ ] SEPTIC TANK'[ ]. Size_-___-_ _____.,.._ ------------ Liquid Liquid Depth ---------------------_____ -- t I 1 . Capacity -------------------- Type _-------------------- Material.-__ .____ ___ No. Compartments 6\ Distance to nearest: Well __ -- __ .._Foundat` )_ _ __ .__ Prop. Line ___ __.__ - t I gEACHING'LINE [ ] No. of Lines -------------------------- ____ _____ -_ __ ength of each line_ _____Total Length ,____ f t 'D' Box ------------ Type Filter Material -_____________-_,Depth filter Material .--------------------------------------.__._ Distance to nearest: Well ------------------------" Foundation _____ _____ +)Property Line _--__-__.__ SEEPAGE PIT [ ] Depth __ _______ Diameter -_------------- Number ber _______ ________._ _ Rock Filled Yes '❑ No .0 I: Water Table Depth_ 4 RockSize -- - -- Distance to nearest: Well _____.__ _ _____________�__._Faunda- i.on! ------- ._ __..�__ Prop. Line ...................... R REPAil ADDITION Prev. Sanitation Permit# ---------------------------_-_ _.__-___ Date ______ ___________________I__.) .) k (Specify Requirements) ---- --------------------------------- ----------------- - Se}tic Ta f Disposal ;Field pecify Requirements) � r , ,� p• t ! -- ---- -- --- (Draw existing and required addition on reverse side) j 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 ggents signature certifies the following: "1 certify that in the performance of the work for whichthis permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------,�------ ---- ----- r- ------------ Owner _ - g -- -- -- .t°'k ! Y �" Title -- ------ ®- - -------- I -- - - --- --------- - ----- ---- !! (If of er t owner) y ""_ ,\�TMENT USE ONLY 61�.' APPLICATION ACCEPTE BY ( DATE q!,,�7 .6 ISSUED —� { BUILDING P, ' �' - -- - ---- --.---- - ----DATE - --------- ----------------------------- ADDITIONALCOMMENTS -------- ----------- - ------ -------------- - ---------------------------------- ------------------ -------------------------------- ------------------ ----------- --- ----------------- -------- ------ - -----• --------------------------=--------------------------------------------------------------------------------------------- ll - --------------- ----------------------- - -------- -- ------- ------------------------------------ --------------- Final Insect p pion by: --------- --------- --- -- --- -- ---- -----------------------------------=--------------------------------.Date .----�/__-' -------=�-�---------------- AQUIN LOCAL HEALTH DISTRICT _. E. H. 9 Ill 68 Rev. 5M