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FOR OFFICE USE: --------------------------------------------------------- a ---------------------------------------------------------- APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Permit No. --(('- �, -_5p Date Issued _&'30 Application is hereby made to the San Joaquin Local Health District for a per 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 --------------------------- [ ----------------------------------------CENSUS TRACT,___ �7-•� -- Owner's Name Ql r__&I --------p� [�r'� Il_1-------------------------- ------ -------Phone Address )`` �?��l 1 / j5 1� %1�-, _city _46_4--------------------------------j-----�-----�8-- Contractor's Name----4)_�" License # Phone Installation will serve: Residence jg Apartment House,❑ Commercial ❑Trailer Court ;❑ / Motel E] Other -------------------- ------ ------------- Number of living units: ---- Number of bedrooms ______.Garbage Grin d - Lot Size .�.�¢____ Water Supply: Public System and name ----------------------•----_--------- �- ---------------_-- -------- _ --------Private Character of soil to a depth of, 3.feet: --Sand ❑ Silt ❑ Clay ❑� Peat ❑� 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:[ ] Size -�----- /----------------- Liquid Depth --'-�j-------.-.--- Capacity _d U� _____ TypeP/Material-l.__6fYA____- moo. Compartments fu -- 0 =) -•-•----•--- Distance to nearest: Well ____c,770_____________________Foundation __ d__________ Prop. Line _ LEACHING LINE No. of Lines ----- Total Len th _______________ ------- LEACHING l Length off each line �� _ 'D' Box ------------ Type Filter Material ►c-Q_�---- Depth Filter Material_%P_____________________________________ Distance to nearest: Well --- �------------ Foundation ___1_____________ Property Line __________________ of SEEPAGE PIT [ ] Depth ________________ ___ Diameter ��----- Number _____- __.__._�___-__ Rock Filled Yes No Water Table Depth ------------------------------------------------ Rock Size JA y Distance to nearest: Well ---------- 8 ----------------- Foundation __1_6 ------------ Prop. Line ___s5______________ REPAIR/ADDITION (Prev. Sanitation Permit # ________________ ____________ Date ----------------------------------) , t SepticTank (Specify Requirements) --- ---------------------------------------------------------------------------------------------- --------------------------- Disposal Field (Specify Requirements) __________________ -- - - -- - - -- - - -- - --- - -- - - - - - - -- - - - - -- - - -- - - - - - - - ---- - -- - - - - -- - - - -- - - --- - - -- - - - --- - - - - - -- - - - --- - - - -- - --- - - - - -- - -- -- - - - - -- - - - -- - - - -- - - - --- - - --- - --- - - - -- - - - --- - - --- - -- - - - - -- - -- - - --- - - - - -- - - - -- - - - - - - - -- - ---- (Draw existing and required addition on reverse side) 4 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 manner as to become subject to Workman's Compensation laws of California." Signed---�--------- - ---------------------- `-------------. Owner By ------------ --------- n -o n -------------- Title -------------------------- ---- ------- (!f other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY i f DATE 10_--�__-.6�_--------- BUILDING PERMIT ISSUED _ 1'�f_ _l�I��S----COA$ Tf_R �),F-D-----�10-----------DATE ADDITIONAL COMMENTS __4t- tkI_L R_T W.r - le``G�----- ------------------------------------------------------ - -- - --- - - - - - - - -- - - -- - -- - - -- - - -- - - - - -- - - -- - - - - -- - - --- - - --- - --- - - --- - --- - - --- - - - - ---- - - - --- - - --- - --- - - -- - - --- - - - -- - - - --- - - -- - - - --- - - - - - - - - -- - - - -- - - --- - - --- - - - -- - - - -- -- --- - --- - - -- - - - - -- - - - -- - - -- - - - - --- - -- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------- 1--------------*"--------------------------------------------------------------------------------------- ----------------------- --------------------------- Final Inspection by: �.�?y�' �.-�------------ ---------------------------------------------------------- - --------------- Date. � { � v-------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I�:II[•il�•f l;1��•7iri1