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r - u FAR OFFICE USE: APPLICATION FOR SANITATION PERMIT -'� Permit No. - --- ---- -------------------------------------- � (Complete in Triplicate) -- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 349 and existing Rules and Regulations: ,r� JOB ADDRESSAOCATION -)--#SSZ---:-+�-----14WX---/ZO-------------- d't---CENSUS TRACT --- -` ----- Owner's Namfe' - ------- HAPu t :`--/,L)0j\J_1__C_f4.1----------------------------------__----------n--------Phone ------------------------------------ Address ------T�'� �-------- ------t't --------12;0----- -: -. City ._/-�L-rcp --------------------------------------------- Contractor s Name ------ w-- 4-----.License # ------- - ------------- Phone -------------------- ......... will serve: Residence _ Fpartment Houselb"lCommercial :❑Trailer Court !C] Motel Other's------------------------ '----------------- +'v 1 t A ' Number of living units:___.f_____ Number of- edroonis -_Garbage Grinder I -. ._ Lot 5ize -- ---.----- Water Supply: Public System and`name ---0- --i---------------------------------------------------------------------'- ------------Private [ _ Character of soil to a depth of 3 feet: Son,&E] Silt❑ Clay E] Peat&--- Sandy Loam Clay Loam E] Hardpan �] Adobe E] 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 j `4 NEW[NSTAdkiriONl (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) In PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-----------------------------------------------� iquid-bepth _--------------.-------- r Capacity - ------------- Type ---- --------------- Material---------------------- No. omp rtments ------------------.._. Distance to nearest: Well ____ ____________________________Foundation ------------- _______ Prop. Line ________________----__ LEACHING LINE [ ] No.-of �Lines�--___________________ L ngth of each line---------------------------- T tal Length ------------------------ --- D' _- s D' Box ----------- Type Filter,M terial _--_______________Depth Filter Materi i __________ Distance t6 nearest: Well _____'`- y______________ Foundation ----- ------------------ Property Line ---------.-..._.__-_•___ i ,. SEEPAGE PIT [ ] Depth ____ _._.___. _._ Diamefier -________.__ Number ____________________________ Rock Filled Yes ❑ No i❑ i WaterTable Depfh --------------- --------------------- --------Rock Size ---------------- ----------- - Distance to nearest: Well -__ ____________________________Foundation --------_--_I______ Prop. Line -----------........... r I v REPAIR/ADDITION(Prev. Sanitation Permit-#-:------------------ -------------------------- Date ------------------------..-------I 1� Septic Tank (Specify Requirements) l---- 0-lST~ / Q X '-- "" ------ -- __ .,.1� W--- -/ham Disposal Field {Specify-Requlreme`r # nts) T"1 � k ____________________________________ i -------------- _--_--- _---- ______________________________________ -- _____ _.__ ? ________________I .- T.. _______r_-_-__________-___-_______________________._______-"--.___--------___.________________-______ Al (�raw existing and require addition on reverse side) I hereby certify that I have prepared]this iipplication and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules 64,46"g,ulations of the San Joaquin Local Health District. Home owner or licen- sed agents si nature certifies the following: "I certify th in the pert a of the wor for which this ermit is issued, I shall not employ any person in such manner as to bec a subject to an's Compen 'on laws�of liforgia." Signe ------ ,___. _ _ ---- Owner I —11f=4C_----. Title -- ---- -------------------------------- ------------------- (If other than owner) , i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------�s R '---------- ------ =f DATE � f BUILDINGPERMIT ISSUED ---------------------------------------------- •--------- -------- ----- --------DATE ---------- ----------------------------- ADDITIONALCOMMENTS ----------------------- -------------------------------- ------------------------------- - ----------------------- _ - ....�. - = ------------------------------------- ----- .� f �n�a[ �1- - - - '/ o -_ _ -{- 1 -__ - -_--_._�__._ �.� __.- - - - y __�_ - - - - -- Final Inspection_ Date _. SAN JOAQUIN 'LOCAL-HEALTH DISTRICT -> T' E. H. 9 1-'6B Rev. 5M