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FOR OFFICE USE: .; s APPLICATION FOR SANITATION PERMIT ---------- ----------------------------------------- .. .. Permit No. (Complete in Triplicate) --------------------_----------- ------------------------ This Permit Expires 1 Year From Date Issued 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 ----- D I.{'----------S-TA_I` _Iz1 _b ---------------------CENSUS TRACT Owner's Name .__ 4�______c:1_54 - - =- -------Phone 3 ------- ---- ------------------------ -------------- qq� p Address = St�PfO_ -------------1 y d �{ ---------- rGEl---------------------. City e- - ------------------------------------------------ Contractor's ----------------------------------------- - - Contractor's Name ------- -------------------------------------------------- ----- Phone ------------------------------ '��C-!J�'s� License # ----- - ----------- Installation will serve: Residence ❑Apartment House❑ Commercial Trailer Court ',❑ Motel ❑ Other ------M_0h 44�77 --. --__M 6— ' Number of living units:___________ Number of bedrooms - ----------Garbage Grinder ------------ Lot Size _/_000 Water Supply: Public System and name ------Cet'#'iA------W_&At^---------------------------------------------------------------------Private ❑ Character of soil to a depth of-3 feet: Sand'❑-• Silt El_ --Clay .❑ Peat❑ Sandy Loam . Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Material ----- ------ If yes, type ---------------------------- F (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) s NEW INSTALLATION: (No septic tank or seepage pit permittedwf prul5li serp i vale within 200 feet,) PACKAGE TREATMENT [ I SEPTICTANKX Size____ _ _ __ _ ____._ ------.________ Liquid Depth --/___,____. Capacity 1r $ ._ IT e Material____________'____.___ No. Compartments --- "--------- Distance to nearest: Wel ----------- Y,---- ---______Foundation _________________-Prop. Line --___-__ _-______ LEACHING LINE No. of Lines -------��--------- Length of each li:�ailter ___________ Total Length�.__ _- ----C?________. 'D' Box ____'_______ Type Filter Material __ Material -------l- -• _______________________ Distance to nearest: Well ___:/�',A�--______ Foundation __ -------- Property Line _- ------- SEEPAGE PIT [ Depth - --------------- Diameter ------ ________ Number ---------------------------- Rock Filled Yes ❑ No ❑ :F �,. Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation _ Prop. Line .................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------- -_---. Date ----------------------------------- Septic _____________.__ ----_Septic Tank (Specify Requirements) ---------------------------------- -----------------------------------------------------------:-----------------.-•-------------------------- Disposal Field (Specify Requirements) ------------ -------------------------------------------------------- ---------------------------------'--------------------------- . --- -- - - -- -------- ------- Draw ----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 performanc f the work for which this permit is issued, I shall -not employ any person in such manner 6 as to becom subject to Workm Compensation laws of California." Signed, ------ ---- --------------- ------ -- - ------------------ Owner BY -------------- - Title - ------------------------------------------ ------------------------------------- (If ----------------- -- --------------------------------- (If other than owner) t OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY L�I� - -- -- -------- ------- ------ --- -- ---------------- -----------. DATE ----- =r � 7. ------- t BUILDING PERMIT ISSUED ------------------------ DATE ------------------------------------------- ADDITIONAL # COMMENTS -. --- __-- '---------------------------- ------------ ----------------- -- ---------------------- - .1. = ' ----------------------- ----- 'It, - ------------------------------------------------ ---------------- -- ---- - --------- ----------------------- ----------------- -------------------------------------------------------- ---- e��✓ Final Irispecfiion by: __-- -------___ - --rte_ t7 7 7 - ----�1.5�----------------------------------------.Date ---/__- � -�------------- - -- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT F. H. 9 i-'68 Rev. 5M