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r FOR OFFICE..USE: APPLICATION FOR SANITATION PERMIT (Completb in Triplicate) Permit No. ...7_... _..•... . ..- ...... This Permit Expires I Year From Date Issued Date issued I 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 ADDRE5S/i.00ATION ,..;L.jO-_�to.,...S.ino1�- r r �._ ...� CENSUS TRACT ........ .. ..._ E?wner's o: _ - - ... _. . ,� :. .,. ,. �. 4-b..�:-��'S�.�"' . •..---•--....---- .......•............................. •--•-• .........................Phone AddressSaIA .......................................................... I --•--•............ ... ............ City --------S-t-kn_.................- Contractor's Name ._B1,ap-RaT41-'-.s---Szz)-t -E... ' n1-C....--•----------------------License # -.2-68,95-1-.. Phone .��3"X0 8 ....... ................... Installation will serve: Residence E] Apartment House l] Commercial [JTrailer Court Motel [IOther k0 .............. Number of living units:........'._ Number of bedrooms ------------Garbage Grinder ------------ Lot Size .................:............... . Water Supply: Public System and name ............... ......•._Cit-Y Private ❑ Character of soil to a depth of 3�et: Sand E] Silt❑ -Clay ❑ Peat 0 Sandy Loam 0 Clay Loam 0 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,) •-�-, PACKAGE TREATMENTSEPTIC TANK ' 9 [ [ � Size................ ...........-- ....... Liquid Depth -•--------................• Capacity ... •-• Type. ------------ -- .................... Material....................•- No., Com artments Distan'c'e,to nearest: Well .....................................Foundation ......._......__._.... Prop. Line ................... % LEACHING LINE [ ] No. of Lines D Length of suds line...-' ..._. Total Length . ` 'D' Box ..........1. Type Filter`Ma eerial-' `---"""'-q;Ddp-th -Filter-Mawial _ ... Distance to nearest: Well ..._---___--_-_--- Foundation ........... • ---••--•-..,.. Property Line ....... SEEP AGE_ PIT [ Depth ._ "....------ Diameter ----25-_.._-- Number ------..?...... ... ...... Rock Filled Yes No 90 � 2�� V) Water Table Depth f Rock Size ... ...... Distance to nearest: Well �. =7.... Foundations r Prop. Line _._, Q--'............ IR/ADDITIONPrev. Sanitation'Permit ( �# ....�.:. ..................... . . Date ........................... -Septic Tank (Specify Requirements) ....... ..... Y' - -.._...--------.................. t ----------------- •-----...--------------------------------• _. 4t Disposal Field (Specify Requirements) v 2•---48AX2�t- P i t-g.... . . _--------- � --- --- . .............. ...................... ..............................................................__.....___.....____..__.....______...___....___...__................._.............._....._(Draw FF1 existing and required addition on reverse side) I hereby certify that I have prepared is application an that the"work will be done in accordance with San Joaquin County Ordinances, Slate Law`s, arid-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." Signed ....---•............... • s ---- Owner i, B � ...__... y .. ......... .. . Title ..............CQn�r: Qr Y ---•-- (if other than owner) 'FOR DEPARTMENT USE ONLY Y APPLICATION ACCEPTED BY . `"� DATE .. 1.:S, _---,••••.,-• 1 1f .......................................... ..................... •--•--. BUILDING PERMIT ISSUED ...................... ..:._......------••---.. _ ..--- -• -• -------•-• - -------......DATE . .._.... ADDIT N L p COMMENT _... ........- � �J -------•--•----------------- ..............................................---------•--•-- . ............. -••........... . .... . ' ---- -- --- -- Final inspection by: _. Date SA JOAQUIN_.LOCAL.HEALTH DISTRICT E. k. 13 24 t_1AA S►u