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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y ,Q q 3b (Complete in Triplicate) - Permit No. -_-- ------------------------------- ---------- -------------.---------- This Permit Expires ] Year From Date Issued Date Issued 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 --' Ge—ele-aaliiq-_ ire L,-"-.-CENSUS TRACT -------------------------- !r �a Owner's Name F'P �- cv-t �J- 7L-' -------------------------------------------------.------------__---------------------Phone 4ews-- 40—a Address ---------- -------------------------- ------ ----------------- -- ------ ---- - --- City Contractor's Nam _ -r -` _t --.V ----OL6l '-__.License # -------------- Phone4ZA�=Jk/ Installation will serve: Residence Apartment House❑ Commercial f7Trailee Court i }} Motel ❑ Other -------- --------------- ------ + Number of living units:.... Number of bedro ms __ ---- age GrinXd �/ Lot Size -- C ---------k---- ... t .. I Water Supply: Public System and name-- Q� _ �_______________ Private ❑ --------------- ---- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ w — Hardpan E] AdobeFill Material -----.-.----_---__f es, type_----7 (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be plced 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 ---- f -- ---- - --.-- ----. '...-' ___---- No. Compartments ------------- Capacity TYPe , - -- Material I 6 `}"— k Distance to nearest: Well __-_._d" "-___ ____ ---_-------F undation '"--_-""'`" "Prop. Line _--.------_._`_._ i INE [ ] No, of Lines ---------------- -__-_ Length of each line---..---_____.------ ------ Total Length ---- L_ D' Box ------------ Type Filter Mcfteriaf --------------------Depth Filter Material -------------.___-- # ------------------------ Proper Line --------- ----------- 140- 4 Distance to nearest: Well � ------------- Foundation Property SEEPAGE PIT ( ] Depth .-- .� Diameter Number --- Rock Filled Yes ❑ No i❑ }-"-a+'E.wr ram. I Water T& e`Depth�` ---------- ------------------------- f-Rock Size - ----- � � {� I Distance to nearest::Well ---------1--------•-----------------!-Foundation -------------------- Prop. Line -------------- REPAIR ADDIT[CIN P(Prev. Sanitation Per ----- - --F-.------------------------------ Date ------------ -------- Septic Tank (Specify Reguirements) ------------------------------I— t -. ----------------------------------------- 00 Dis sal Field e��'Requirements) -- - - ------ `--- ----------------- - --- --�__UPPLEMENTAKYJVIN -- {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 a County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health (district. Home owner of sed agents agents signature certifies the following- "I certify that in the performance of the work for which this permit ivissued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------- -------- % E BY --C�--r!'�'"" - Title ----- -- --- SEPT 0f CFLh&gF��. ! 4 I 2915 E.Miner Ave., • HO.6-3841 TOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ A) N'. .15tP�_.� E � G ------------------------------ DATE --------- ; BUILDING PERMIT ISSUED ------------------- ----------------- t DATE ------------- ENTS ---COMMENTS -__- _-.-_ _- ��xI ---------------- -----------?2------ 6 f ------------------------------------------------------------------------------------------------------------------------------ --- --- ----------- Final Inspection by: -- ------ L---------- ---------------------------------------------------------------------------------------------- -- -- ---- ------ ---- --Date --7 6 SAN JOAQUIN LOCAL HEALTH DISTRICT x E=H. 9 1-'b8 Rev. 5M