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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- ---------------------------------------------------- Permit No. ___7e-------� - ----------------- -------�-------- - {Complete in Triplicate) ------ ---------=------------------ ---------------------------- Date Issued -----_-----_-----_-------- -----------------------_-_ This Permit Expires 1 Year From Date Issued s 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: o3y5= s__ : s_ ! ---------------------- . JOB ADDRESS/LOCATIO __ _CENSUS TRACT ---;__- - --•- Owner's Name �Z =----------------------------------------------------------Phone -- ---------- Contractor's lz�1�-��-----� �_�N��---------��--------------- City -----�S-09 La---_------------------------ •-• - •- - - Contractor's Name 16VJ,/fV-FUA---------------------- ------------------------------------License # ---------:-------------- Phone --------------.------------ Installation will serve: Residence ❑Apartment House'❑ Commercial []Trailer Court ',❑_A �. '•� Motel ❑ Other . , ',. `------------------------ --------- Number of living units:----I------ Number of bedrooms JZ,,_ ___Garbage Grinder ------------ Lot Size`---------------- Water Supply: Public System and name ----------------- ` '---------------------- ------------------------------.---------------- Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑. Peat E] Sandy Loam ,0. Clay Loam-0. Hardpan s❑ Adobe E] Fill Material _ __ If yes,type _________._________---_____ (Plot plan, showing size of lot, location of systemnl relation to`wells, buildings, etc. must be placed on reverse side.) \ s,. NEW INSTALLATION: (No septic tank or seepage t permitted.if public sewer is availab Ja within-200 feet,] PACKAGE TREATMENT { ] SEPTIC TANK'( ] Size-------_---��'------------------- Liquid Depth --------------------,----- Capacity ----- -------------- Type - ------------------ Material- ----------' == N D. Compartments ----------------- W Distance to nearest: .Well __ _________________________________Foundation '.,____ _ _ Prop. Line ____.__________...... - i LEACHING LINE [ ] No, of Lines ________________________ Length of each lix�e'____ ------- Total Length ----------- _--_______._..- L•` 'D' Box --------..-- Type Filter aterial --------------------Depth Filter Ma erial ----------------------------------------•--- Distance to nearest:,-Well.,- _.____-___-________._.F,oundat.ion,-._----------------- --- Property Line ________________________ SEEPAGE PIT [ ] Depth Ro& Filled Yes No ' Diame r Number ❑ ► k`titti`::-- '3�1 G :.-_1 Rock Size ---------- c Water Table Depth ------------ ----------------------- - -----------....---- Distance to nearest: Well _._ ________________________________Foundation -___ ___________ Prop. Line -------------- REPAIR/ADDITION(Prev. Sanitation Permit# _.-_- Date i ----------------------------- "-� ) Septic Tank (Specify Requirements) --- ------------------------------------------------------------- ------------------------------------- -- ------------- ..... Disposal Field (Specify Requirements) --- -------------� ---------X.E14C"1.....1-_[-1�------------------------- --------------------------------------------------------------------------------------------------------------- ----------------------- ------------------------- ------------------- ----------------- --------------------- --------------------------------------------------------------------------------------------------------- --- (Draw existing and required addition 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 ignature certifies the following: "I certify t in the performs ce of the work for which this permit is issued, I shall not employ any person in such manner as to bec a subject toV 'an's Compensation laws of California." Signed ---- -------I-------------------------- Owner By ------ ----------- ------- ---------------- `-- -- ------------------------- cA-V'----- Title ------------- ----------------------------------- ------------------ (If other than owner] Li� 7 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------T5 `©---------------------------------------------- ------------------------ DATE ------ BUILDING ----BUILDING PERMIT ISSUED ---=-------- -------- ------------------------------------------------------------------ ---------DATE --- ----- -.-_. ADDITIONAL-COMM-ENTS '----- ----="---_-----=--T=--- �--,�--= ------- - ------------------- �. _ �' -----------fit - ----------------------- ------ ------------------------------------------ _____- ____- --------- --------- -��T^�- _______. .___-___------- --- ___ _ _ -tel•-rel• _ FinalIns on by: - - - -- -----'------- ----- - ---- -- ----------------------------- ---------- Date ------ --------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1268 Rev. 5M .