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r 1 f FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT x ----------------------------------- - (Complete in Triplicate) Permit No: ._.72--21I.-D. ------------------------------------- Date Issued ._3_-__ __7-Z This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Districtfora per 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 .--- _�°-C3 _____,__ - T____ 1�J21f=---- i _ '..�:_..:_",'`, _CENSUS TRACT -------------------------- Owner's Name �f1�i .�,iaF+m .. �"1 R_I'C-i- ... •-------------------Phone+C 3-"P-�I�l--- ------------ - -------- AddressJS-�0 U IOC Q city Contractor's Name ---------------------•---------------------------------------------------------=-------.License.# =------:-------------- Phone ------------------------------ t Installation will serve. Residence ❑ Apartment House❑ Commercial:❑Trailer Court-',Q -- _ Motel ❑ Other _Md ; r-------140Y,110---------- Number of living units_____________ Number of bedrooms --- .....Garbage Grinder __4C---.. Lot SizetS-a1_______ Water Supply: Public System and name ------�-----------------------------------------------------------------------------•------------------Private Character of soil to a depth of 3 feet: Sand'EJ Silt❑ Clay ❑ Peat❑ Sandy Loam [/ Clay Loam F1 Hardpan ❑ Adobe'❑ Fill Material ___________ If yes, type ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) �I NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK Size---/rjQ V____6-_t�._________ Liquid Depth ________________________ Capacity -------------------- Type -------------------- Material---_-----------i------ No. Compartments - Distance to nearest: Well ------ Q_ T____________Foundation ----- _____ Prop. Line __________-__-__..__ LEACHING LINE Ij No. of Lines ------rL________ Length of each line_______, 0------------- Total Length ---------- 'D' ___.._. _'D' Box _---NO-- Type Filter Material /1& .Depth Filter Material --------------------________________________ Distance to nearest: Well ------�_q 2?!�_____ Foundation ________________________ Property Line _________________.___.__ SEEPAGE PIT [ ] Depth ____________________ Diameter ________________ Number ---------.--_____.-_________ Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size ---------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -----_-----.._..---.-- REPAIR/ADDITION(Prev. Sanitation Permit# -.------.----------------------------------- Date --------------------.-----.-------} , SepticTank (Specify Requirements) ------------------- -------------------------------------------------------------------------------------------••------------- ---- -------- Disposal Field (Specify Requirements) ---------- ---------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) -- - I hereby certify that I 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- 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 as to become subject to Workman's Compensation laws of California." 4 i Signed ------- --------------------------------- P ------- r. Owner ---- ------------ ----------.-. --- ------------------------BY --- - Title (If other tha caner _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - -------- ---. DATE ------------------- ------------------------------------------ BUILDING PERMIT ISSUED ----------------------------------0-__l-------- ------DATE -------------•---------- ADDITIONALCOMMENTS ------------------------------------------------------------------------------------ ----------------------------------------- --------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - _: -- - �, - -- ----- ------------------�-----3---��-------------- --- - -- - - Final Inspection by - 2?�� ate SAN JOAQUIN LOCAL HEALTH DIS ICf F. H. 9 1-'fsR Rev. SM 1