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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------- --- -------- Permit Na. r (Complete in Triplicate) --------------------------------------------------------- This Permit Expires 1I Year From Date Issued Date Issued t 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 .--2--`�---0-2- CENSUS TRACT 7. c Owner's Name y �p ` '- Phone Address c`y�_3- ---- "___ 1_q-�-�%--------h�.------ --- <. CP 4-Ur� R 1af D-X .`City -- Contractor's Name -----4w(VEi----------------------------------------------------------License # ----------- Phone ---------------.-----__ Installation will serve: Residence [] Apartment House❑ Commercial�❑Trailer#mo",t Motel ❑ Other --..___ \\ Number of living units:----/---- Number of bedrooms __Garbage 'Grin de� a Lot Size AzR_iEG� __ Water Supply. Public System and name ---------------------------------------- ,.---------------------------------Private �r 3t Character of soil to a depth of 3 feet: Sand'❑ Silt❑..='Clay ❑ J eat]]Z`�Sandy Loam Clay Loam ❑ Hardpan E:],.,-Adobe E], .Fill Material _.________ if yes, type ______.____________________ (Plot plan, showing size of lot, location of system in rel6ition to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage it permitted if publicseweris available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK:[,q- _____________ Liquid Depth ----M ------------ Capacity __----_---. p y _____ Type F eriaLR7-No. Compartments -"- --_ W Ca acit �_ __I' _ Mat . t t tante to nearest: Well -- ----- __ _---._.Foundation ... Prop. Line ... _____________ r �— Length of eadr-line.____ Q------------- Total Length ._____�......---------- - LEACHING LINE [ No. of Lines ------ ----------------- g �j r < 'D' Box��_�-�.__ Type Filter Material t &49_ --- Filter Material ------l_ _________________________________ ; v+ : / Distance to nearest: Well -1� --.-------__ Foundation ....10------------- Property Line .......... SEEPAGE PiT [ ] Depth ----------- ----- Diameter --- ----------- Nuiriber ---------------------------- Rock Filled ' Yes ❑ No C] Water Table Depth ----------------------rte- ------- --'--._-Rock-Size -----------------------•-------- ^ ---Distance to nearest: Wel! ____________ _________________________Foundation -------------------- Prop. Line .___._____.._........_ REPAIR/ADDITION(Prev. Sanitation Permit# ------------------- ----------------------- Date -----------------.-..--------------) SepticTank (Specify Requirements) ------------------- ___________?T-___-____-___----____------_----__----__--___.-_____ --__-__.-.-.--------�..� ------------------------ {1 Q Disposal Field (Specify Requirements) -------------------------------------------------------------------------------- -------------------------------- --------------- -------------------------- --------------- ----------------- ---------------- ------- ------- - --- --------- ------ - .r _ - y i4 ----------------------- - --------------' ' ------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and'ihat 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 sign Lure certifies the following: "I'certify that the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to beco subject to W an's Comp nsati.on laws of California." Signed -- ---- ------ ---- --- -- -- - -- ---------------------------=-=------------- Owner By -------- -------------------------------------- ----------------------------------�cR 0- Title ---------------------------------------------- -------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY : ' 1 F�` --------------------------------------------------------- --------------------- DATE --- L` -'? - BUILDING PERMIT ISSUED ----------------------------------------------- -------------------------- --"-- ------- -- -- - - ---DATE --------------.-------- ----�--- ---- ADDITIONAL COMMENTS- -- - ----------•----- ------ '`•. -----. --- -- ---- - ---- --- ------------------------------------------------------ - ------------- --------------------- ------ -- - - ---- - ------ -- ----- - f - Final Inspec ' �s --- - -- ------------------------------- ----Date --- 4 `-7 '- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'S8 Rev. 5M