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FOR OFFICE USE:--------------- APPLICATION FOR SANITATION PERMIT Permit No. _._7y-�_�_ (Complete in Triplicate) ' Date Issued --- ------------------ -----_---___r_-,____----------------- This Permit Expires 1 Year From Date-lssued Applicati6n-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/LOCAYA N � --------_f__V�►- ------ -J7_ - 5--------------------CENSUS TRACT (�Owner's Name / -------i___�7-E. �-F-I------------------------------------�--�/--------------------Phone ------------------------------------ Address -------- 716------ti- ------- --Z 554; 11_ -----------. City ---'� —tv --------------------------------------- Contractor's Name -------WN M-------------'- ---.License # ----- ---- - -- -------- Phone -------------------•----- ---- Installation will serve: Residence ❑Apartment House❑ Commercial ❑TrailerEvvrt i�� ,�.. Motel-❑Other -------------------------------------------- Number of living units------r------ Nvmber�of-bedrooms =----Garbage Grinder NO--- Lot Size ___A-CRF_7n'� ----------- Water Supply: Public System and name ----------------- ---------------------------------------------------------------------------------------------Private ®� A\ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ 1 Peat ❑ Sandy Loam ❑ Clay Loam "24-1f" �y Hardpan ❑ Adobe ❑ Fill Material ---. O- If yes, type ---------------------------- . �V (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 seep f permitted if public sewer is available within 200 feet,) y (^ PACKAGE TREATMENT { ] SEPTIC TANK'[7 Size-----:�rX_ ja__X_.,�77------ Liquid Depth ____,ZA________________ 1 Capacity ---- Type Compartments � 1 � ------ to _____ toT ______�__________ _____ 4 __ _____ p _______-___________..___..istance nearest: Well --- Founcatlon _ LEACHING LINE [ No. of Lines `___ ---------------- Length of each line'__A-V�_____.______ Total Length i r �C 'D' Box „- ,i Type r ppd Depth Filter Material ____1�__________________ �.�_ T e Filter,,M��aterial r?______ ________ I _ _ Distance to nearest: Well _L�__" �-__ Foundation --- ------- ---=-- Property Line _----____` `_-__- SEEPAGE PIT [ ] Depth --------------------- Diameter ---------------- Number ------Q----------------------- Rock Filled Yes ❑ No I❑ Q Wafter Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ______-__--___-__________________) SepticTank (Specify Requirements) --------------------------------------- -------------------------------------------- ---------------------------------- Disposal Field (Specify Requirements) ---------------- ------------------------------------------------ --------------- ------------------ ----------------------------------------- -------- ----------- ------- ------------------------------------------------------------------ -------------------------------- (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 agent signature certifies the following: "I certify t at in tjrp pert anc of the work for which this permit is issued, I shall not employ any person in such manner as to bec e s ct to 's Compensation laws of California." Signed ---- -- --------e4 _ Owner By - ----------------------------------------------------------------------------�r\` ---- Title ---- ---- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ ------- -PN r ---------------_-----------------`"--------------- ----------- "DATE ------ r BUILDING PERMIT. ISSUED ---------------------- - - - ----DATE__ -- ----- ---------- ADDITIONAL COMMENTS - _ .__._ ------------------------------- -------` '�`� - :__ _ _ - - -------------------------=------------------------------------- ------ e5w.. r Ga -- ,5•�.e ------a--- - -- ---------- ion-by:Inspect ___--_--__---Date ------ -- S- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M � ;