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FOR OFFICE USE: , APPLICATION FOR SANITATION PERMIT u ` .� , 7 --------------------- Permit No: (Complete in Triplicate) --------------- ------------------------------------------ -� r Date Issued _____ - ------------�P--------------------------- This Permit Expires 1 Year From Date Issued 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: i JOB ADDRESS/LOC ON _2�2'�`f12--� O�.I- --------------------------------------.-----CENSUS TRACT 5_715"C) ------ L. 1 l` ►1EM _ `� Phone �� Owner's Name __.- __ -L -R.T�,• - •- Address ----------2 ' v --------. Ity _�:Q(�I ------------------------•---- ®1tS11V , � - eAALicense #--------------------------- Phone Contractor's Name ______- ` Installation will serve: Residence partment Nouse,Fl Commercial ❑Trailer Court ;❑ Motel ❑ Other --------=------ ------------ / f� _14GR �4C --------------• ; Number of living units:-----I-_____ Number of bedrooms _,3__---Garbage Grinder _ __-_____ Lot Size Private Water Supply: Public System and name ----- -------------------------------- -- t .. . / . �CIa Loam...- .. (' .Character-of-soil-to,a depth-of 3-feet:�Sandtr'j]-- Silt-p° Clay=❑f'-Peat4EF' 5andyrL'oam y p t ❑ )❑_ r—' _____-____ Hard an Adobe Fill�Material _��1-'if yes,.type�-__�;,;,;�-_-___-- [Plot plan, showing size of lot, location of tem in relatio tq wells,-buildings, etc!,,mkT5t be p ced on reverse side.) ` y NEW INSTALLATION: (No septic tank or seepage it permitted if public sewer is available within�Od feet,) ,_ -�. r Li ui8Depth ------------•-- PACKAGE TREATMENT [ ] � SEPTIC TANK'[ ] ! ------Size__ Mafi iai__ __________ ________� No. Conp�rtments _____..------.----•--- p Capacity Type - t k Distance to nearest: Well _.___-_____- _---oundatidn=----------------- --'Prop. line --- .____-- :.__-.--- 1.1 i ----=---------- 1. ._ LEACHING LINE [ ) No. of Lines ------------------------ Length of each ine--.--------------------- Length -----------------------•---- . _ Total L�n, r - ------------ ' 'D'. Box __._____.-- Type Filter Material ------------- ------Depth Filter Material ------- --;-------------------- I ------ -- �� } I E Fou dation ------------------ Propety Line Distance to nearest: Well ___________________ ____ l( E �-. SEEPAGE PIT ] Depth - --- ------ - ----- Diameter ------ . -bel ---------------------------- Rock Filled Yes ❑ No [ tines t - E Water Table Depth ------------ '--Rock Size -------------------- ^ - _:_ } P;op• tine --------------------•- istance to PeamiY#Well p oundatian - i ----- REPAIRfADDITION(Prev. !Sanitationate ______-.__ 1 - l � d! __ Septic Tank (Specify Requirements) ___-Foa---t3#�TI I_RQNI- -� FA � � =T} �------ --- - �Q__-- 6 Disposal Feld (Specify, Requirements) ___ __.__ 4 ------------------------ f --------------------------- ------- ----------------- a n reverse side)existing and required'addition o I hereby certify that 1 have prepared this application and that the work will be done in accordaisce with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home caner or licen- sed agents signature_certifies the following: �1 "I certify�t t in t performance of-the work for which this'•.,permit is issu. d, I shall not employ any person pn such manner as to be a jectV 1Vorkman's Compensation laws of California." ---------------------- -- -- -- Owngr Signed --- - -- ----------- -------------------- ' ----- ------------- - i 13 - Title:= ----------- ----- - - - - - - - --- -- - - ---- (If other than owner) FOR DEPARTMENT USE ONLY ' DATE - `_L 3 .7 APPLICATION ACCEPTED;.BY __�T`-�'- -- ' ----•----- ----------------------------------- kBUILDING`PERMIT"-ISSUED - - m- ^ � -------DA'T£ ------- -----•---- - ADDITIONAL COMMENTS __.n±1Et 4 __'13-toi±n iP+�1__ `'t' _k-- '- -- =`µ �--R/P-lt1l-----•-Imo[«---------------------- ------- ----- ---------- --------------------------- ------------- j ---------------------- -- -- ------ ---- --------- - ------- --- - - -- ---------------------------------------------------- - - - - - - ----------------------------------- �_�_ Final inspection by: __ - ------ ------- -------'----- ----------- - -----.Date -- --- - - SAN JOAQUIN LOCAL HEALTH ,DISTRICT 6 E. H. 9 1-'68 Rev. 5M {