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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---- Permit No. - -- --------- ------------- ---------- - �Q_ (Complete in Triplicate) This Permit Expires 1 Year From bate Issued Date Issued ------------_--------- ---------------__-------------_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described; Th' ap Ip kation is made in compliance with County Ordinance No. 549 an existing Rules and Regulations: JOB ADDRESS/LOCATION ./�`= L,'� d L& C !1----(�f3?��C 910VNSt S TRA T - Owner's Name --- ------ l- t ----le-e � 7 ------Phone - 7.. --•--• City'W44, -7-I`- �S Address - -- =' .............................. - - p 66_- Contractor's Name ______--- ---`___ - License # /-`------�_ pone -+ -= ��- ` - ----------- Installation will serve: I Residence [Apartment House❑ Com ercial ❑Trailer Court ;❑ Motel ❑Other -- ------- ----------------------------p- 1 Number of living -units:_ti._ __--.'�1umber of bedrooms _7 =-Garbage Grinder 102.1 Lot Size`.'-7 f w - Water Supply:Public System and name -------------------------------------------------------------------------------------------------------------Private [ Character of soil to a depth\of feet: Sand'[ Silt'[] Clay ❑ Peat ❑ Sandy Loam ❑ -Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material Nf�---- If yes, type -__.--__.__------- --------- (PlotP Ian, 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,) a PACKAGE TREATMENT [ ] SEPTIC TANK,'[ ] Size------------------------------------------------ Liquid Depth -------------------------- Capacity --------------\ Type -------------------- Material---------------------- No. Compartments --------••-•---------- Distance to nearest: Well------------------------------------Foundation ---------------------- Prop. Line ---------------,------ LEACHING LINE [ ] No. of Lines ------------ Length,of, each line'__ -------------------- Total Length ---------------------------- 'D' Box ------------- Type Filter Material -------------------- Depth"Filter`Material -------------------- -.-,--.------ Distance to nearest: Well ------------------------ .Foundation ---------------- - Property Line ------------------------ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number - ----------------- Rock Fiiled Yes ❑ No 0 Water Table Depth ------- ----------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------_--_-------------Foundation -------------------- Prop. Line ----.__ .............. REPAIR/ADDITION(Prev, Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic ----_--_-----.-------------------Se tic Tank (Specify Requirements) CV- )-A— ---- 1 ------------ ra Disposal Field (Specify Require ments) _----------------ej/ ----- ----- ------ ---- ---`----- ---- 7 Q ------------ -------------------------------I ---- ----------------------------------------------------------------------------------------------=----------------------------------------- (Draw existing and required addition on reverse side l, _ _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 agents signature certifies the following: "I certify that in the performance of the work For which this permit is issued, I shall not employ a;»y person in such manner as to become subject to Workman's Compensation laws of California." Signed --lf� ------ Owner ------------------------ By ---------- ------------------------------------------ -title --- ----------------------- -------------------------------------- (if other than owner) FOR DEPARTMENT USE ONLY _�.. r--------- APPLICATION ACCEPTED BY �.-��-t�---------- ------------:._:.------ -- '-�-`---- - DATE �-- --2� `--�-- BUILDING PERMIT ISSUED - .S --y ,, ` ---- ''--- t DATE ----------- - ADDITIONALCOMMENTS = ----------------------- --- -------------------------- ----------------------- ------------------ ------------------------------------ ----- - --- ------------------ ---- ---------------------- ------------------------- ------------------ - ------------- -------------------------------- ------- ------- --- ----------------------- -------- ----- -- ---------- ------ - ------------- ----------- ------- -- --� ---------�------ ------------------------------------ -- ------ - ------------------------------------ ---- Finallnspection € ----------------------------------Date r SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M