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FOR OFFICE USE: APPLICATION FAR,SANITATION PERMIT ` I . ' 96 u (Complete in Triplicate) Permit No:....`.......... ..... - 3 ...................... ... ................. This Permit Expires ii Year From Dote 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/LOCATION ...I:.fi !_:_: !�!l.._J �ti�`'`-�!` ...........................CENSUS TRACT .......................... Owner's Nome ............................+ - --- ....... ..................Phone - Address ........... .......... _&-.7—V......2'.---- - . City --- ------ - - 0 Address ....... Contractor's Name ......... -�. .. ... Ala.";U-17.... ' -------- --- ---- ...........----........ --•--License #��-��.�.:. Phone Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court 0 ; � Motel ❑Other ............................................ r 1 2 Number of living units ....... 3_._ Number of bedrooms ... .....Garbage Grinder ..__ Lot Size ....�_b...x.�w................ Water Supply: Public System and name ------------ --------------------•- ---------------- --.. .....-4-...------. = = Private ❑ Character of soil to a depth of 3 feet: Sand 0 .Silt 0 Clay ❑ Peat0 Sandy Loam ❑ Clay Loom ❑ Hardpan ❑ AdobeFill Material ............ If yes, type ............... Y (Plot plan, showing size of lot, location' of%stem in relation for 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[ ] Size------------------------------------------------ Liquid Depth ------- N4t.a.wr fn. Capacity .................... Type • ..f:... Material...................... No. Compartments /// Distance to nearest: Well7'_ .......................... _.. :t._. Foundation ...................... Prop. Line ...__..... ...... LEACHING LINE [ ] No. of Lines -------- __- Length of each line............................ Total Length.............................5 _ N'D,Box Type Filter Mater�i'al":...._.._... _..Depth Filter Material -' Distance to nearest: Well ............... ....... Foundation ........................ Property Line ..:-................... F j SEEPAGE PIT [ j Depth Diameter ....� ........ Number ............. .............. Rock Filled Yes,[] No i❑ .., ' Water Table Depth � .........Rock Size � ; _.Distance to nearest: Well -----•... l ' ...Foundation ..... Prop. Lina .3 I REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..........:....................... ) Septic Tank (Specify Requirements) ...................... ..........:....: - _: rr r .. _....._......._..._... ....... Disposal Field (Specify Requirements) ............... i'�........... -- _...........-...........................__..._._ ----------------------------•--••-•--..... ----•-•--••------...--• •. ...------------•--•------------------------------- --------------------------------------•---------------- •----...._._.:.............---..................•. - K ( u -----••-- -- ------------------. (Draw existing and required add tion on reverse side) 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: "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:" r Signed ------------------------ •`--•- .. .._... ... Owner ......... ...............:: ................ ile ......-By ............. .._...... ._...._. .........s„ . ... II( owner) ' FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED SY .. ........-•-••. BUILDING PERMIT ISSUED ----------------------------------------'....f.. -•----...:...._.....---------- .... ......------.._DATE ........-----•--.......--•-- .............. ADDITIONALCOMMENTS ...................................•---------•---------------•---=- ------------------------.................................. ....... ... $ ----------•......... ..............................................................................................................._.............-...................---................................. # ..........................................................._.........................._....................................................... ............................ --•--•• ...............----------------._......_..Y...rr:_ :.. .............. ._. ....... + Final inspection by: _...:.... ----W=z.- .. <.� !.......... ....Date . ..... .-.... ..... .....-- 1 J Q..-....... SAN'JOA8UIN ILOCAL HEALTH DISTRICT E. H.Z3 241-'68 Rev. 5M 7 72 3 M .