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FOR OFFICE USE: APPLICATION)FOR SANITATION PERMIT71 —36-0 ----------------------------------------------------- :�_I Permit No. -. ----------------- (Complete in Triplicate) ___________________.__._.__.________._ ��!.__. This Permit Expires 1 Year From Date Issued Date Issued - -yO....... 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 wCounty Opoinance No. 549nd, existing Rules and Regulations: OB ADDRESS/LOC TI �_ _z�m.a_ ._,CST_ ��_iNf A9114-1-&—A�__-a S._��.a._.__CENSUS, TRACT __. C� � To fir; Owner's Name _ o_ �r =fir« ------------------------------••--- -------- ---- :--_-.-:_.- -_---..:Phone r--------------------------------------------------------------•--. City .Sc46�¢-- .��Qh-� 4 Contractor's Name Address `_-_. _. _�___ r ` -��7I -�•----------------------------- License # Phone e: Residence Apartment House Commercial ❑Trailer Court ;❑ Installation will sere e Motel ❑ Other --------------------------- ------------ n - -•- ; f Number of living units:-__/G._____ Number of bedrooms g 1�?�� 3U.��_-- ________Garba e Grinder __________._ Lot Size ____3 ___ __ _ _________ __ IMS Water Supply: Public System and name --------------------------------------------------------------------------------------------------- Private ❑ Character of soil to a depthlof 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam r Hardpan ❑ Adobe❑ Fill Material ------------ If yes,type _:_____ -:__________<___— _ w (Plot plan, showing size old lot, location of system/ren to wells: buildings, etc. must be placed on reverse side.) NEW INSTALLATION- {No septic tank or seepage ed if public sewer i3 available within 200 feet,) / PACKAGE TRI_ATMENT �[ ]i� SEPTIC TANK X e____ _ _____ .________ Liquid Depth -----f--- ____:Capacity l _ _______ Type® Material e No. Compartments ___�.�__________'Distance to nearest: Well -------------------Foundation -rZ-0--r-- -- Prop. Line ----5----=-------- LEACHING LINE [ No. of Lines __�___.____________ gf each ii e__..._V___U.`r_._`_.___ Total Length ___%2__ J _L k'D'IBox _ __ Type Filter Materialr ____.__De th Filter Material __l� � ------------- - ------------------------------------- IDistance to nearest: Well _ _��__._________ Foundation l__ l________ Property Line.,__ t_____________ i SEEPAGE PIT [ ] r !Depth -------------------- Dia eter -------_--.----- Nu ber _.__'a�__- ----------- Rock Filled Yes'❑ No i❑ Wal er Table De -------------- Rack Size i ------ Distance to neare t: el _._ _______________Foundation -------------------- Prop. Line _.______..____.__....- REPAIR/ADDITION(Prev-. Sanitation Permit ____ _____________+:` -. _____________ Date --------------------------------- j :I Septic Tank (Specify Req irements) ----------- .__ E ti Disposal Field (Specify IN Requirements) ----------------- -------------------------------------------------------------------- �,; = - -------- --------i ------------------------- --------------- --------------- ------`-------------- _ (Draw existing and required addition on reverse side) -F I hereby certify that I hov 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 g r a Compensation laws of California." r r ` f Signed ------------------------ Owner+ as to ecome�stok Wol-��----- Y -- BY -------------------------------- -h-------- ---- ------------ Title ----f- - --- -- -------------- (If other than'owner) FOR DEPARTMENT USE ONLY ` t ,M . APPLICATION ACCEPTED BY DATE -Fz - ---------- BUILDING � = - - --- DATE - ADDITIONAL COMMENTS A------------------ ------------ ---------- - - �(-------------- ---------------------------------- -- ---- ------- --- -- ----- -------------------------------- ---- iM -------- ------ -------------------------------------------- ----------- --------------------------------- -- -------- -- -Date ---------.._`----------------------------- ------------------------------------- ---------- ------- ----- -------- --- ---------------- Final Inspection by �[ -- -------------------------------- ------------------- ------ ---- SAN JOAQUIN LOCALVEALTH DISTRICT E. H. 9 1-'68 Rev. 5M