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F,OR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 ----------------- -- ------------------------- ------- 7/ 0 (Complete in Triplicate) Permit No. _ _ _�______________ _.--------•.-----------r----------:!�---------------------- Date Issued/._O---L = � ----------------------------_----------_--_ _--------- 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: JOB ADDRESS/LOCATION -_.13 ------Zs___.__� -- ------ ---CENSUS TRACT ----------------_.._..____ I if Owner's Name ![ CJ• { -� ------------------- /f Phone Address --- ----- - 4 ---•--4 -------------------------------- city --- z��------------------------------------ Contractor's Name ._,Gr 1. -.---�.----,7 _X_1------- --------.License # _ �_2.C_? ---- Phone _. 33a-v j Installation will serve- Residence Apartment Housef] Commercial ❑Trailer Court 0 Motel ❑Other ------- -------------------•- Number of living units:----/----- Number of bedrooms _____Garbage Grinder -_'-________ Lot Size --_ ---------- Water Supply. Public System and name ____Pli�__ ----- ______________Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam Hardpan Adobe ❑ -Fill Material _-_.__. k_.. If yes, type ___________________________ F L (Plot plan, 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,) PACKAGE TREATMENT [ � SEPTIC TANK)Q Size------/a-X_X7A_Z4!------------------- Liquid Depth ----------4------___,____ Capacity __49-0,0---- Type _4- ' Material-_ *"' No. Compartments --------a$2--.___--___ Distance to nearest: Well ---------If-11....................Founda'tion ------f0!-------- Prop. Line --- -------------- LEACHING LINE A No. of Lines -------A-____________ Length of each line____-/ a_`-__.._.____ Total Length -----9A----_________- D' BoxIf.___t_.-__ Type Filter Material -- � _ .Depth Filter Material ________ j--________________________ A Distance to nearest: Well _____-"q----------- Foundation -----14-!---------- Property Line --------17 SEEPAGE PIT Depth ---5;S/------ Diameter _3111______ Number -------------�________ Rock-Filled -Yes A No i❑ Water Table Depth -------IGD-!-----------------------•--•----Rock Size -------------- -------------- - Distance to nearest: Well --------14�----------------------_Foundation ___ ----- Prop. Line ------47�........ REPAIR/ADDITION(Prey. Sanitation Permit# --------_----------------------------------- Date ----------------------- ---------- Septic Tank (Specify Requirements) ----------------- ----------------------------------------------------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------=------------- ---------- - ti _______ ____________________ _____ _ .,: (Draw existing and required addition on reverse-side] s. 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: s "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 - �[ B �_c! m .�Q------ �T.fJ F - ---------------- Title ----- / - j ' -- (if other than owner) ) FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY ./,;Z44_- ----- - ------ ----------------------------------------- -- DATE jd' - 7------------------ BUILDING PERMIT ISSUED -.---.-_-- ____-- _ DATE ------------------------------ ------------• ADDITIONAL COMMENTS --- ---- � _________� ----_t '- '- __-- ------------------------------------------------------------------ --------- -A----------- --------------------- -------------------------- Final - - Final Inspection by: Date -.~ --------------------7 - u. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M