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FOR OFFICE USE: Q _ APPLICATION FOR SANITATION PERMIT -------------------- >ter- -- (Complete in Triplicate) Permit Permit No. .- --- This Permit Expires T Year From Date Issued Date Issued -0`�7d 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/. -, l Z- � r rt_5...... u '---------------- ---------------------CENSUS TRACT ---------------------•--•- Owner's Name �-------- _ `.�. ...._ ` ,•.`ti° ,.,,.+ ------ ---- ne - Address ` >� p. �'_. _>. ---%%J!..-_. City ---- ------- - s ------------------------------------- Contractor s Name __------.-"'/�_._..t_�'�-_ w_�'-'-�--"--- �.e;a�S; .License # ------------------------- I }�- - �--------.-- Phone ------------------------------ � : i Installation will serve: Residence'LApartment House❑ Commercial ❑Trailer Court i❑ ✓ Motel ❑ Other ' .`°� a i Number of living units:-/ Number of bedroo�iis"�` =___Garbage Grinder _.______._ Lot Size - _�____---- rS4 Water Supply: Public System and name d- ,7s_. L __Ii;_r------------------- __Private ❑ Character of soil to a depth of 3 feet: Sand'_� Silt❑ Clay E] Peat❑ ; 'Sandy Loam E] Clay,Loam :❑ I Hardpan [ Adobe Fill Material ---------I_ If yes,type ---------------------------- L; (Plot plan, showing size of lot, location of s.stem in relation to wells, buildings, etc. must be placed,on reverse side.) �. i I -ii 11'` F { n!d X.sv i1 NEW INSTALLATION: (No septic tank or,seepage pit permitted if public sewer is ay.oilabi�?within 20d�-feet,) PACKAGE TREATMENT [ ] SEPTIC TANK! i 1Size___l_2-OA07""4 ! tion .-q;e --------- Liquid Depth ---------------- --------- Capacity ---- -------t Type ------ 'r y Material Cn No. Compartments `✓-------------- Distance to nearest: Well ---------i---- --------------------Foundation ---------------------- Prop. Line ---------------------- LEACHWG LINE [ ] No. of Lines _4N g ---- Length Len th ,of teach Elme--___7,VV---T-- Total Length _/ _ __.._--- 'D' Box __ __ Type Filter Material ____________________Depth Filter Material --------------------__ Distance to nearest:rWell _ o `' ------- Foundation ._-- ----------------------------- Property Line --------------------- SEEPAGE PIT [ j Depth l.5'__.._T_ :Diameter- - ° Number --.__�5 _'__________ Rock Filled Yes J21/ No .,� Water Table Depth �- ------------------- - ----- -----------Rock Size !`-z' '' -�---------- - t l Distance to nearest: Well .1_4V_-__-1097------ -----------Foundation Lv__f7____ Prop. Line .......... i •M k REPAIR/ADDITION(Prev. Sanitation Permit�# _ ___________________-________ .•__m._,Date ___._�_____________.______________) Septic Tank (Specify Requirements) -:--- - ---------------------'------------f_----------___-t-----_ Disposal Field (Specify Requirements) J ----------------- , t 0 ------------------------------------- f � ::; - „ Draw ex-stin and required ad---------------------------------------------'�:4-;-a-------------------------------------------------------------------- t � �; } a'., ( g q dition,on reveise side) I hereby certify that I have prepared this application and that-the-work-will be done in accordance with San Joaquin t County Ordinances, State Laws, and Rules an"d)Regulations lof the,5an Joaquin Local Health District. Home owner or licen- sed sed agents signature certifies the following: & f ` "I certify that in the performance"ofthevrork f which this permittis issued, I shall notemploy any person in such manner Ie as to become subject to Workman's Com ensaiion laws of California." 5ignedji,. f�y� -- -------------------------------------------- ,Owners BY -- -----------------------'----------------------------------- Title ------ (If other than owner) lI, • . ... .«,.......... �.:.,..... .•x 313 ': �s:. FOR DEPARTMENT USE ONLY x APPLICATION ACCEPTED BY -------------------------- ---------------------- ------------ DATE .--- -------------------------------------- } BUILDING PERMIT ISSUED ------------------------- ------------------------------------------- ---- ----- -------- ------ - ---DATE ------------------------------------------- ADDITIONAL COMMENTS --------------------------------- 1 ----------- ----------------------------------------------------------------------------- ----I----------------- ------- ---I------------------------ ------------------------- -------- �------- - ------------------ ----------------------- -------------------------------------------- Final Inspection by: A Date � -- ---- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M