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FOR OFFICE USE: � APPLICATION'FOR SANITATION PERMIT / q - -- ------------------._._•__ Permit No. _._(� 1 -,? (Complete in Triplicate) - ------=---------- ------------------------------------ ------------------------------------------______----------- This Permit Expires ] Year From Date Issued Date Issued __. _____3/� Application is hereby made to the San Joaquin Local Health District forr a permit to construct and instal) the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ------------809--Sneed---Rd------- --CENSUS TRACT Owner's Name --------------------4oa_o----Campos--------------------- -------Phone Address ------------------ �3 ci 1 d:-------=-------------------------•------------------- City _:_Fri h__0ata Contractor's Name -------oariile--T-------------Qno-y—W----------------------•---------.License # y r __ Phone ----------------- Installation will serve: Residence [N Apartment House-[] Commercial ❑Trailer Court Motel ❑ Other -------------------------------------------- Number of living units:------I____ Number of bedrooms ---3-------Garbage Grinder no:--____ Lot Size ----5_3_2_225 Water Supply: Public System and name -------------------------------------------------------------- ------------------------------------------------Private Character of soil to a depth of 3 feet: Sand ❑ Siltk] Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam i❑ 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 TREATMENT [ } SEPTIC TANK:[ ] Size-----------1-x200------------------ Liquid Depth ----------------..__,..... Capacity ---- ----- ----------- Type ------------------- Material---------------------- No. Compartments --- -= Q j Distance to nearest: Well _--5o------------------------------Foundation _.._ -------------.Prop. Line ___-_ _ LEACHING LINE [ ] No. of Lines -4-------------------- Length of each line----------43--------.------ Total Length .---.--_.---- ' 'D' Box -----k____ Type Filter Material ____________________Depth Filter Material ---------------------------------_--__-:•-.. Distance to nearest: Well ___go________________ Foundation --------6-9 Property Line. ---------5________-.:_--- SEEPAGE PIT [ ] Depth __------------_----- Diameter _______________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth --------- --------------------------------------Rock Size -------------------------------- !t Distance to nearest: Well ----------------------------------------Foundation -------------- ---- Prop. Line -------------:__.--_.. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------..--------------) Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------:--- --------- •---------------•--•-----,.... i Disposal Field (Specify Requirements) ----------- ----------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------- -------------------------- - -------------------- ----- -------------------------------------------------------------------------------------------------------------------------------------- (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 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 -----------------:osp--CeaPo--------------- ------- Owner By ------ ------•------- ------ ;title ----- ------------ ---------------------------------- ---------------------------------------------------------- - - ----------- - - Ilf other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- '17415-_._. -----• DATE ---�.-_z_0_77 6__7--_------- 3 ----------------------------------------------------------- BUILDING PERMIT ISSUED -- ----- ------------------------------------------------------------------------------------------------DATE ------------------------------------ ---•- ADDITIONALCOMMENTS __'------------------------------------------------------------------------------------------------- ------------------------------=-------•------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- - --- -------------------------------------------------------------- ---------------------------------------------r - Final Inspection by: - Date ------fes _--.----_--------' -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. w