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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT g ------- ------------------------------ Permit No- -7[)_"�l f_- This Permit Expires 1 Year From Date Issued Date Issue (Complete in Triplicate) ----------------------------------------------------- - __-.o"��/Q. a O. f-F t r !Z 1 O - 03 d 1s A pl ca ion is hereby made to the an Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance /- ,C with County Ordinance No. 549 exjs ' g Rules and Regulations! JOB ADDRESS LOCATION .__l`�3__0 ------------/V -------- -----".--11- `-......... ------- -n--/-CI Sf1S TRACT --- ---- Owner's Name --- P_Tte ,S- N_{--�- -Z _w�. __`TW� '�� f' Phone _ �D4- _�OQ_ V._.- Address --------J e;7 ta------------------------ ------------------------------------------------- City -------------------------------------------------------------------•-•------ Contractor's Name --------- e�eloqz--------------------------------------------------------License # ---------:-------------- Phone --------------------.._......_ Installation will serve: Residence ❑ Apartment House[] Commercial railer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:----Z__ Number of bedrooms ____-__Garbage Grinder __^___- Lot Size ---._A_t_ _____!T Oeo _ Water Supply: Public System and name _-_700LV e-/f-______-__ -t-1 ---/-- t� --------------------------Private ❑ Character of soil to a depth of 3 feet: Sand b Silt K Clay ❑ Peat E] Sandy Loam ,❑ Clay Loam ❑ 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 I ] Size______________________________________________ Liquid Depth _______________....______ r� Capacity -- ---------------- Type -------------------- Material---------------------- No. Compartments --------------------•- Distance to nearest: Well ___________________________________Foundation ____________________ Prop. Line ---------------------- LEACHING LINE [ ] No. of Lines ________________________ Length of each line---.______________________ Total Length _-_________-.__--_--___-___. 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------.-------..--_-_----•_--- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ----------------- SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes [] No i❑ Water Table Depth ---------------------------- -------------------Rock Size -------------------------------- C_ Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line _-_-____-._____...__.. ' REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date __________________-_-.__________) Septic Tank (Specify Requirements) ----------------------------------------------------------- ----- N► Disposal Field (Specify Requirements) ------ ----------. - ---------- -----_-- --------- ----------------- ---------- --------------------------- ----------------------- (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 matinee as to become s?>rsrt to Wrkman's Compensation laws of California." Signe a _________-------------- Owner -- Title ------------------------------------------------------------------------ (If other than owner) F DEPARTMENT USE ONLY ,�-�•� APPLICATION ACCEPTED BYS..Q+---- ---------- ----------------------------------------- DATE - BUILDING PERMIT ISSUED --------------------------------------------------•-------------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ------------- - -- - ------ ------- ----------------------------------------------------------------------------------------- ---------------------- ---------------- -------------------------�A,_ ------- ------------ -------- - ---------------------------------------------------------------------------------------------------------------- - --------------- -------- ----- ------------------------,--------------------------------------------------------------`-------------- { ------- --- --- --- -------------------------------------------------------------- -------- - s YFinal Inspection by: .___ __ -_ Date _ ___a-- ----- ----- ------------------ r ------ _ --------- - SAN JOAQUIN LOCAL HEALTH ..DISTRICT E. H. 9 1-'b8 Rev. 5M