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FOR OFFICE USE:c APPLICATION FOR SANITATION PERMIT ------------------------------ ----- c�----- 5s (Complete in Triplicate) Permit No: -------------------------- Date Issued --- ----------------------------------------- --------- --------------------_---_----_-_-------_-__ This Permit Expires 1 Year From bate 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 .__ _3.3_7---�,......el- ,r:--------------------------------------------------CENSUS TRACT Owner's Name ' -----06u;,d�__ f--------------------------------------------------- -------Phone r _ Address ----2 -J-0 -A-v--------------------------- ------------ City . 70_e lr&v----------------------- --- Contractor's Name -----Cdr------------License # 24,259 j------ Phone '-- Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other __.------------------------------------------- Number of living units:____.__ Number of bedrooms __ .___Garbage Grinder _A14P-__ Lot Size _sv�- _1• �------------------ Water Supply: Public System and name ----P--elZl C----------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'EJ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam.E] Hardpan ❑ Adobe Fill Material ------------ If yes, type _________---------------- (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,) a^ PACKAGE TREATMENT [ ]'' SEPTIC TANK'[ Size__ .Y_/_l7_________________-kk_--------- Liquid Depth -_�,F------------... ck Capacity _/2_O__o----- Type - Material6_A!,eeAZ&No. Compartments ------2..__.:---- `� _* `1 . - Distance to nearest: Well ---W-&- -e__________________Foundation __/U___----______ Prop. Line __ _____-_______-- LEACHINGLINE [&?�No. of Lines ____2_______________ Length of each line-- ------------------ Total Length ____ ......... 'D' Box ---/------ Type Filter Material _ ____ a :_Depth Filter Material ----- _______________________________ - Distance to nearest: Well --------- Foundation __1U-r-------------- Property Line. ___ .--_ _____ . SEEPAGE PIT [y� Depth __Z- 7--___--_ Diameter _3 F,-_ Number -------/-------------___ Rock Filled Yes �o ❑ Water Table Depth ----,pfl--- r----------------•----------Rock Size ---- ---------------------- i Distance to nearest: Well ___1$le_,v-e-----------_---------Foundation _-CQ-J---------- Prop. Line ___ _________-- }� REPAIR/ADDITION(Prev. Sanitation Permit# ---------/h ---------------------------- Date ---------------------._..----------1 Septic Tank (Specify Requirements) --------------------------------------- Disposal ------------------ ---Disposal Field (Specify Requirements) --------- r - ---------------------------------------------------------------------------------------------- -- I ---------------------------------------------- ------------------ -------------- ------------------------ ----------I---- ---------- --------------- -------------------------------------------------------------------------------- --------------- ----- ---------------------------------- (Draw existing and required-addition on reverse side) I hereby certify that 1 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 ompensation laws of California." • Off^' Signed ev GCS ------------------------- By ----- -------------------------- ---------------------------------------------------------- Title -------------- ------ ------------------------------------------------ (if other than owner) Z,0:�;L"PARTMENT USE ONLY APPLICATION ACCEPTED BY -------- ------ - - - - - - -------------------------------------------------------- DATE ----- _'�--------------- 'l BUILDING PERMIT ISSUED : -------- - ----- -- ---- ------- -------------------- DATE DT!O AL�COMM TS -------- ---- --------- - - ----- -- ---------------------------------------------------------------------------- ---------------------------------- r ------------------- - - ----------------------- ------------------------------r----------------- --- --- ---- ------- --------------------------------------------------------------------------------------------------------------- --------------------- ---------- -------------- - ------ - --- - ------------------------------------------------- ---------------- -------------� - - Final Inspection by --- - ------ ----- -- -- -- ----------------------------------------------------------Date ----- K-. 0 S O N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5