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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------------•- Permit No. - - - -------------- ---- �.-`r�x7 - - (Complete in Triplicate} ------------------------------- -------------- p Date Issued This Permit Expires 1Year From_ 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 -: ef_0 �� CENSUS TRACT T_'17__•-----_-..--- i Owner's Name ._ , .e - ------------1J z/y_l_/V_JCJ_ / Phone ` 1 © � )�� , Cit �� s�_f ---- Address --------.., -� 8 , ---------r/ ~ ------------`��------------q-----,._�"NC.Y -YXC— ---- - �4. i Contractor's Name --------- --------------'1'`jcs _'SRJ 1 1PArse.License # -I �_� - Phone - -$-- --• Installation will serve: Residence R, Apartment House❑ Commercial :❑Trailer Court `,❑ Motel ❑Other -------------------------------------------- Number of living units:----If------- Number of bedrooms -Z------Garbage Grinder -.---__-- - Lot Size ------_-- --__------- Water - -- - ---- ---------------------------- -------------Private Water Supply: Public System and name ----------------------------------•-------- --- ------ ----- - - Character of soil to a depth of 3 feet: Sand'[-] Silt❑ Clay ❑ Peat❑ Sandy Loam X Clay Loam n Hardpan EJ Adobe r-1FillMaterial ------------ If yes,type -_-------.-__------------- C I IJ [Plot plan, showing size of lof, 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,) 1 PACKAGE TREATMENT [ ] SEPTIC TANK'( gp. Si e-------------__------ --------- - ----- Liquid Depth -----------}}-----------.- 0.. Material- No. Compartments ¢ JCapacity _�- I9_ --.--- Type - ---- - - i Foundation - ---------- Prop. Line <-�-f Distance to nearest: Well --__-��5--------------------- � LEACHING LINE f� No. of Lines Length`of•each'line I Q�-------- --.- Total Len 91h � gr D' Box __ ---- Type Filter Material �- epth Filter Material ----------------------------•�--•----•- i . �------------- Property Line -- TO-•---------- Distance #o nearest: Well ----�-C?_---__ --_-- Foundation _ SEEPAGE PVT ] p !Z --------- Dicimeter 31-------Number ----_o ---------- ---- Rock Filled Yes No �] Depth ----_-�_-- — Water Table Depth --------- -------------`----.-------Rock Size -------------------------------- Distance ----------------------- -Distance to nearest: Well __117-01 -- ----------Fo-un dation ---- Prop. Line ....1-- ------•--- REPAIR/ADDITION(Prev. Sanitation Permit r# ------------------------- ----------------- Date -------------------- ) Septic Tank (Specify Requirements) -------------------- ------------------------- ------------ ----- -------- ------------------------------- ----- - ---------------- Disposal Field (Specify Requirements) ------------ ------------------------ -------------------------------------------------- ---------------------- -- --------------------------------------------------------- --------- ----- ----------- ' --------------------------- ---- - --- Draw-existi- -- ng 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, 1 shall not employ any person in such manner as to become subject to Wor man's Compensation laws of California." � Signed ---• - -------- •- ,PiJ Owner -------------- ------------- ---- Title ---- ---- ---- ----- ----------- ----------- ---------------- (If ---- - --------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- - --- -- ��---------------------------------------------------------------- DATE _77A7--n-;7f------------------- BUILDING PERMIT ISSUED ------------------------- -- --- -------------------------------------------------- s DATE . -- -------------------------------------- ADDITIONAL COMMENTS -------------------- ------------------------- -- ---------- --------------------------- ---------------- - ------ ------------------------ -- ------ - ----------------------------------------------------------------------------- ---------------------------- Date Final Inspection by. SAN JOAQUIN LOCAL HEALTH DISTRICT u o 1_'AR Rav_ 5M '