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r� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - - 7,19 o ► - Permit N - -- o. - iE�• .- �� (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 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: JOB ADDRESS/LOCATTION ��/ l 0.-- i--------- -----------------------------------CENSUS TRACT -------------------------- Owner's Name .--f' 6�v �/lam /�`f U� ------------------------ ------ Phone ------------------------------------ Address --------* -----------------•--------------------------- --. City F -------------------------------•------ ------------------ p Contractor's Name _______ � � �� -r _______.License #/�- _/-Z Phone'J Klf - � ----------------------- Installation will serve: Residence. Apartment House�❑ Commercial ❑Trailer Court '.❑ Motel ❑Other -------------------------------------------- Number of living units.---./,-'--- Number of bedrooms _p�_____Gaa-r�bage Grinder ./ Lot Size .. 1 _- -` ,-_____________ Water Supply: Public System and name _a.�/./r-_-_4r14k 2x___-,S C _—o e.-----------------_t---_-__- Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam -- — : Hardpan ❑ Adobe;9 Fill Material ------------ If yes;type ______________________ .� t (Piot plan, showing 'size.of lot, location of system in relation to wells, buildings, etc.S must be placed-on reverse side.) NEW INSTALLATION: fNo septic tank.or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size________________________________________ Liquid Depth ____.____--__--_-__--.___-_ f Capacity .-- `-------------- Type -------------------- Material---------------------- No. Compartments ------- ------------- Distance to nearest: Well -------------------------Foundation ---------------------- Prop. Line ---------------------- V1 LEACHING LINE [ ] No. of Lines _______________________ Length of eachline---------------------------- Total Length ------ --------------------- 'D' Box?-------------Type Filter Material --------------------Depth Filter Material .------------------------------------.------ Distance to nearest: Well _______________________ Foundation _.__._--_- ------------- Property Line. ____-_____________-____- N SEEPAGE PIT [ I Depth __ Diameter ________________ Number -- Rock Filled Yes 0 No ❑ Water Table Depth ----------------------------------------- -----Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _..................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ____________-_____________________) Septic Tank (Specify Requirements) ---- -------------- --- --------- ------- Disposal Field (SpecifyRequirements)'_----Q -- --------- ------ 641 ?----,a_. -------------------------------- ----- yam --------------- ---------.------- ---------------- ----------------=---------------------------------- ' (Draw existing and required addition on reverse side) 1 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: _, r "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------------------- Owner By ------ ----�e4= ' Title � � - - ---------- -------------- flf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- �-----------`----------------------------------------------------------- DATE ---------------- BUILDING PERMIT ISSUED ---------- -- ---------- ----- -- ---DATE --- -------------------------------------- ------------------------------------------------------------------ - ADDITIONAL COMMENTS ------------------------------ -- - - ------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - - - - ------------------------------------------------------------------------------------------------------------ - Final Inspection by: --------------- ----Date ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M