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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT —7-I-- --------------- ---- ----------------------------------- (Complete in Triplicate) Permit No-717-1-0-1 ------------------------ -------------------------- Date Issued -------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein G described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 99 �� c . JOB ADDRESS/LOCATION .__V _ . rr-Z._ ---s]---- 1 / ' IV---J ------ -lNSUS TRACT ...... Owner's Name -------5P-_t_2_t ---------- -----------------------------------------------Phone�-7_0/C_.a�. .------ Address _f_ _ � 1�� --------------------------•--. City - _&_4 �i ------------------------------------------------- `/ License 3F'=-------f�--� Phone _> --6'�. Contractor's Name ---� �-- ----- Xe---------------------------- - -- Installation will serve: Residence g Apartment House�❑ Commercial ❑Trailer Court 0 ` t /__ Motel ❑ Other -- --------------------------------- -- Number of living units:_.__ Number of bedrooms____--Garbage Grinde�7� Lot Size --l------ ---- f'- ------------ Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private-[Z Character of soil to a depth of 3 feet: Sand?a Silt❑ Clay ❑ Peat EJSandy Loam F] Clay Loam❑ Hardpan E] Adobe L] Fill Material ___ If yes, type ---------------------------- s (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be ploce'd on reverse side.) NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Jen ze--------------------------- ---------------- �'� iquid Depth _.- .------.--------.----- �Q Capacity ----------- -------- ----------- -------- Material---------- ----- No Compartments -----------•-•-------- Q Distance to nearest: ------ ------------------------Found --------- ------------ Prop. Line -----------.- .------ LEACHING LINE [ j No. of Lines -------------- - Len th of each line---------- ---- ---- - Total Length ------------------.-I--,---- 'D' Box ------------ Type Mat rial ___________________Depthr terial ________---_________._._--_-------_---_.-. Distance to nearest: Well Foundation ___ ___ ________- Property Line _______________ ....... PIT [ j Depth __________________ Dter '•. _______ Number ----_._ _ ______---- Rock Filled Yes ❑ No ❑Water Table Depth --- -- --------------------------------Rock S ----------------------------- bistance to nearest: W ----------------------------------FoundPrap. Line -----...-----------_-- REPAIRIADDITiON(Prey. Sanitation Permit# __'- -------------------------------- Date _____________.-----__-_-) Septic Tank'IS-pecify-Requirementsrl�,.--------`--- 1-- ------------------------------- -------------------------------- --------- - ----- - --------- Disposal Fi7d (S iFy R�quiremen s} . / L' /p _7-7_��`� ----------- /_d_i✓ . �_. , -------- --------------------- ----------------------------------------- - ------------------ ------------------------_--------_________________,__:: `__.___________________-________.__ __-___________ ____-_______________________________________ __^____ t i -------------- - ,. t t mak- ---{Draw existing and-required addition on reverse side) I hereby certify 1hat l have prepared this application`ancl that the work will be done in accordance'(44th 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 haws-of-California." ! 1 .a. Signed -- r� ' ------ kOwner By ------- a `h ---------- Title ------ --------------- (If other than owners �x - • FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY I-- - _ -------`' '`'4 �= DATE '"-��'' l BUILDING PERMIT ISSUED -- -------------------------- -------------- E =------ ----- ------------------- DAT ADDITIONAL COMMENTS ------------- ---------- ----- . ------------------------ --------- -- ----------------- - --- ---- -------•- ----------- - - ------------------------------------------------- -- -- ------------------- = - ------- - ----- ---- Final Inspection ----------------------- Date ------------; SAN JOAQUIN LOCAL HEALTH DISTRICT ; V + E. H. 9 1-'6$ Rev. 5M