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i FO.R OFFICE USE: APPLICATION FOR SANITATION PERMIT Of ----- � Q , - --------------•------------------- - Permit No. ;Complete in Triplicate) ---------,--'_ ._. ---------=----------------------------------------------- ---------------- This Permit Expires 1 Year From Date Issued Date Issued _1--_a___� 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- !__--__ r Q-001A HiQ-'-_1�A �_/�NT�L �-. _CENSUS TRACT __--/�-------------- Owner's Name ----- --- -- -- -----------�-� 1?_� � r/---------------------------------------I------------------Phone 3� ?-a� ------- Address -CV y------- -----7 AP o 114e? 404 P t _ -----------------------------•- ... Contractor's Name Licensee- Phone Installation will serve: Residence [! partment House❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other -------------------------------------------- Number of living units:--- ------ Number of bedrooms wZ-_-_--Garbage Grinder Hf'47 Lot Size --------------------- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private [�I Character of soil to a depth of 3 feet: Sancl A�Silt 0 Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material -.W--- 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 tack or p seepage pit permitted if public sewer is available with' feet,) IlkPACKAGE TREATMENT { ] SEPTIC TA Size �%�- �X - _---- Liquid Depth ---------------._---_ Ca aci Type _-____ Materiai4 Na. Compartments r p ty.��0�- T e \ , Distance to nearest: Well _--�?, -------_ --_ Foundation ----------_- Prop. LineQ______________ Vl LEACHING LINE [ ] No. of Lines _�---------------- Lengt each i � ------_-_-- Total Length AiC�Q.-r_._-._-_-__-- ----------- --- 'D' Box � __ Type Filter aterialA90<�------_Depth Material -./!?----------------------------------- 0 Distance to nearest: e I ---�_-----__--_ Foundation .--.----_----- roperty Line IAP----------------- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number --------------_- ----------- Rock Filled Yes ❑ No i❑ WaterTable Depth ------------------------------------------------Rock Size ------ -------------- ---------- Distance ----•- -Distance to nearest:-Well ----------------------------------------Foundation -------------------- Prop. Line -----------._:.._.---- REPAIR/ADDITION{Prev. Sanitation Permit# -------------------------------------------- Date ------------------.---------------I Septic Tank (Specify Requirements) ` -_ --�f --p--ls X- .-: -----__---_ Dis oral Field (Specify Requirements) Sr0 --------------•----------- - -T -�fiso � � , -� s --- El _--- a _ c19,O----csP ,C, , � /,cs. ------------------------------------- --------------- -- --- --------------------------------------------------- - (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 manner as to become ubject to Workman's Compensation laws of California." Signed > /-i�' IATf?� -- ------------------ r I BY ------ Title - - ------------------- f other than own �J Q FOR DEPAitTMENT USE.ONLY p APPLICATION ACCEPTED BY --------`'r_j__R 0----------------------------------- -- - ----------. DATE -----7 /�`6. ---------------- ----- - ----------------- BUILDING PERMIT ISSUED -------------------------------------------------------------- --------------DATE ------------------------------------------- ADDITIONALCOMMENTS ----------------------------------------------------------- - --------------- --------------------------------------------------- --------------------------- -------------- ----------------------- -- --------------- ----- ------------------ 7`Z� X_49_7-- ------ Final Inspect' - -- --- Date - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M