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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �d Permit No. _.-.... �� (Complete in Triplicate) --------------------------f-;-., '� .. .t. Date Issued��_�t�1C} This Permit Expires 1 Year From Date Issued Application is hereb'' 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. 5.49 and existing Rules and Regulations: (� 1� - 51 JOB ADDRESS/LOCATION .Id...-3Q ._-S- .I7}� T- - ----- ...CENSUS TRRACT _.... ' Owner's Name ----•-.._ /2�-Y� /!1/.Tly ---------- "--•-- --------- --------•-- -----•-••- .._Phone4.� --0.7 71-----. Address ..----- 0 -... :-.../T.f�r 'L-f�/Y! -----------------City ------------- _-------------------- Contractor's Name ----7�X_ �-�� -.- ------• ..........License v234R_ -_ Phone Installation will serve: Residence�portment House❑ Commercial ❑Tra',iler Court -[] Motel ❑Other----- ----------- -- ------- ----------•--- t f Number of living units: .l------ Number of bedrooms�------Garbage Grinder -, __-. Lot Size - ._ �---5---•---•••---•-.-- 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 -------t.- If yesI,type --------------------------- (Plot plan, showing size of lot, location of system tin 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 ----_.---.------__---_---- ------------------ Capacity ------•------ - - Type ------ ---- .... Material... No. Compartments Distance to arest..Well—: ------------Foundation ------ Prop. Line ---------------------- LEACHING LINE [ j No. of Lines ----- ---CG L ngth of' ach line--------- - ------•------- Total Length ----.------•----_-----••---- 'D' Box ,---� ._.l-. Type Filter M terial .I.�j_ .___--s----Depth• Filter Material --------------------------------------•••-•- earest: Well ---____ . Foundation .. ."..- --_-__ Property Line ..........--...___-----. Distance to# n , SEEPAGE PIT [ ] Depth . .... ........ Diameter .- #.°-' Number ------ , _._...--_._ Rock Filled Yes ❑ No [] Water Tdble Depth ------ - ----E------------------Rock Size --------- ----------- ----- --- 1 ua ation Prop. Line ...................... Distance,to nearest: Well F.4-.nil --•----- --- .V 1 ' > , k REPAIR/ADDITION(Prev. Sanitation!,Perm # _..._. --------- -Date ____ } ------- ------ - --- i Septic Tank (Specify Requiremen sl ............ --------- - Disposal Field (Specify Require ents] t - `t - - S' "� R� � """"""'"""" . xsr svr - - ------- ----' - - _ S --------•-•-----------__. .-------- ---- ------ ------------ -------- _�......, (Draw existing and required'addipon on reverse side) I hereby certify that I have prepariied ithis application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, andules and Regulations of he San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the fo:lo�inga ► *., 1 certify that In the performance of the work for which this pormit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation leiws of California." j � 3 Signed f 7i ,RT P. -----------------— ----------- ------ BY - 1br - - -............. Title _ (If other than c4etmr FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY i -:O . ---------- DATE .. _. _.-/-4'••--- -- BUILDING PERMIT ISSUED --•- --------- ----DATE ------- --------- ........... ------- ADDITIONAL COMMENTS __.. - ------ -•---------- ------------------------------------ ..._ - -------••--- - ------ --- ------•--• --- ---- - _....". _ ..-----•_....- -----• -- ------- ........ ..............._... -f- ------ Fina! lnspe 4.. ----------.Dae SAN JOAQUIN LOCAL HEALTH DISTRICT r - `� �•'[1 -! E. H. 9 1-'b8 Rev. 5M