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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - -. .....:......._• -------- --•- F: • Permit No. (Complete int Triplicate) __.........._--------------- This Permit Expires I Year From Date Issued Date Issued ././-_6. ? 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 JCounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -?1----.'.`- ----'_w_� Jl .-............-----------CENSUS TRACT ----- Owner's Name --- --•--- - ............. - - / Phone , 6. "36 pS ..___ Address .- ---- ---------- ------Y-3-7-&...... '. [/C1inl y_�CitY ---- ----.--_----------- -.------ --- - �� ---- -/--------------------- Contractor's Name ------------- - -- ----- - -t ,,p- I.C_:G_�_.License # l S Y46 3�Iq� Gf-- Phone Installation will serve: sidence [XAparienent-House❑ Commercial ❑Trailer Court i❑ Motel ❑:Other----'-.. ------- ---------• ---•---- Number of living units:._.-- ...... Number of-bedrooms�:73-1-_Garbage Grinder ............ Lot Size ---"`' ------ ---------------- Water Supply: Public System and name ................____ ..................................................-_-.-_-----------_--___--_-._..•---.-___-Private Character of soil-to a depth of 3-feet: - Sand❑f Silt❑ Clay [] Peat❑ Sandy Loam ❑ Clay Loam Hardpan'[] Adobe [] Fill Material _-._-. ----- If yes,type---------------------------- (Plot plan, showing size of lot, locdtioh 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 t J Size...._......_.................................... Liquid Depth -----._--_-_ ___-_ _-.-=-•----- Ca acitY ---------- -----_-. Type ------•---------- -• Material- - -------- -_______ No. Compartments ................. 4iDstance to nearest: Well '--.`:--:__-t_-. !_______________Foundation ______----_-__-_____. Prop. Line __-__-..._.._:-._____- .LEACHING LINE [ J,' 'No. of Lines _-__--__-_---_--_ Length-.of, each line_------------------------- Total Length .._-. ...................... y 'D' Box --------.--- Type F.ilter.-Material-----------------•--..Depth Filter-Material ------------ ..................... Distance to nearest: Well ________________________ Foundation ---------_---- --.---- Property Line __-_--:_:_:._ - SEEPAGE-PIT [ j Depth -------------------- Diameter ................ Number ---------..........--.------ Rock Filled Yes ❑ I Water Table Depth - -------------------------------------...c-_-.Rock Size ....-----------..............--- t ___ "____--_Foundation __.''`___.--_.__-_... Prop. Line __._._..___ .......... Distance to nearest:�Well ____________________` REPAIR/ADDITION(Prev. Sanitation Permit# _.._.- ................................. Date .-_------------------_------------ ) Septic Tank•,(Specify Requirernerfts) ----------- ) ---------------• ------------- ------------------- -------- - ,.... ----------- --------- �Disposol}�,Field (Specify Req Yreme ts) --n-a.40----- ..---- -_--•-- - .. �;�- - _ --=--------------- ------------ --- --------- --------- (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- ce; .sed agents signature certifies the following: �1 "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 Corn pensation,laws,of California." Signed ----------------------•-•-- -• Owner BY ..---- -- -- ............. .• -------------------------------- (If oth an owner) FOR DEPARTMENT USE ONLY T APPLICATION ACCE TED --------------- ----- DATE _//-.:, -------------- BUILDING PERMIT ISSUED -------------------------------• ..:' �` ?=' DATE .. ....:.•--------- --._. - ••----------------•---- ADDITIONAL COMMENTS ------------- .--------••---_----------- --------•-------------------------------•-- ------------------------- ---------------------------------•----------------------------------------------------------------•------------------------_------ ---------------------------- - -- --•-------- --=----•--•• -- ------ < ------•------- Final Inspection b P Y= �t�- -'--- ---------------- `-"�'- _---•----- -.Date . 7 -_. SAN JOAQUILOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M