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FOR OFFICE= USE: APPLICATION FOR SANITATION PERMIT .... Permit No./ k^�,V (Complete in Triplicate) .............................I............................. This PerrnitExpires 1 Year from Date Issued �7, Date'lssued/.... ----...Z 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 Regulationsi JOB ADDRESS/LOCATION ....IV._Q.AiE_3-, A0-.-7. -e C�__.I�'1 �.............................CENSUS TRACT ...._._.. ....... 4 r Owner's Name Oo.!7E7". �. asr illi..: -- :.....................Phone _.�a'�3.... $ ...... Address ...78ltttt--tr--------------- '•--------•----.-..--------._._...---------------- ............City ►•7` .C�!r......_......__._.......--•------.............-- Contractor's Name .5•�ta±s�r_'��-------..........License # 3S7T4- --4.--- Phone.S -4'_x02-9/0-_ Installation will serve: Residence❑Apartment Houseft Commercial:]Troller Court 0 Motel ❑Other....................................... Number of living units:_.___ Number of bedrooms •...Garbage Grinder ..�S?_ Lot Size ---3CW-00-VJ----------------•• k - Water Supply: Public System and name __........ - - .............. Private Character of soil too depth of 3 feet: Sand l� Silt❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan[Q Adobe 0 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.4 NEIN INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT [ I SEPTIC TANK IL j Size---------------------•..-_...-------_-.._.._.... Liquid Depth ._.._.._..-- w Capacity� ------ Type Ph.. ff57`__ Material-ee-*U47747`_ No. Compartments ---------------=-••. F 1 � Distance to nearest: Well ------------.........................foundation ...J-0- Prop. Line --.3.d:_........-S .2 ... •..____.._. Length of each line-._._7.�............... Total h Lengt ... ryG�..___........W LEACHING LINE [ ] ' No. of Lines � � C 'D' Box - ...... Type Filter Material - /A- ..........Depth Filter Material _._. rfl Distance to nearest. Well ........................ Foundation ............. Property Property Line .-1.5 :..._...`..---. SEEPAGE PIT [ j Depth ---I.---------------- Diameter ---------------- Number ._._..---.. ................ hock Filled Yes ❑ No ❑e Water Table Depth ---------.- ...Rock Size -------------------------------- Distance -- - - --Distance to nearest: Well ----------------•.......................Foundation .................... Prop. tine ................. ---- 1 �f REPAIR/ADDITION#Prev. Sanitation Permitil-` --------------------•---------------- Date--- -------------------- ......... t(•1 SepticTank (Specify Requirements) •------•-------------•-•-•---•- •••-=••...:...•-------••--....:.-•--...........................--•-•---..........._ ..................-- i d - --------- Disposal Field (Specify �C�� fy Requirements) . �.---� -----. �'-----•�?"`•'••---�'�'e.............................. _._.. rte•-tea... ��R 7®... i3-O V .. ... - ......-.�-.�t4 ._.------4K- F� - (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 Mules and Regulations of the San Joaquin Local Health District. Home owner at, licen- sed agents signature certifies the following: pe 4 "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 - ------------------------------------------------------------------------------•....... •--•.... Owner By _.eG_._ _ ................. Title ------ = (if other than owner) f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------------- .___..... DATE .............. __._----- ( BUILDING PERMIT ISSUED ---- ------------------------------------------•-------------DATE - ----------....-----------------•-•----- rADDITIONAL COMMENTS ..... ---------•-- -•----------- --•--•------------------ ........ ....... ----I-----------.--------.-.----------- i - ..-. ......... -------•-------------- .... -- --.._ .----•--- ...--- ----- -------------... ----------- ... ........... _ _ ...- ....._.....----..__...__._.........-•--•- ..... .. ...... . ------• --• .-...•--------- f �z .. ............... _ FinalInspection bY= -•------------------------------- ------ ---•---••------.....Date .. ...----•- --------- Eli 13 2L 1-611 Rev. 5M SAN. JO UIN LOCAL HEALTH DISTRICT 8/7L 3M