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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ------------------------------------------------------ (Complete in Triplicate) This Permit Expires 1 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 N _-�/�.-_!__�!___------1.'�--c�!i�-------�C- —---------- CENSUS TRACT Owner's Name f�_/' llC_ i^_fY�_d N�C �----------- _.�,..- Phone. _ � -7z-/,-[/ d_..1. -- ---. cit ------------------- ------------------ �rj =---------------- Address = c 7- Y / Contractor's Name _____ _ __ /`!H?[- License # "fie---- Phone Installation will serve: Residence Z Apartment House,❑ Commercial :❑Trailer Court ',❑ / Motel ❑ Other -----------------------------------------•-- Number of living units:----- ----- Number of bedrooms ________Garbage Grinder Lot Size _ __ -___ , _ __________________ .g 24 Water Supply: Public System and name ---------------- --- - -------------------------------------------•------------------------- Private Character of soil to a depth of 3 feet: Sand'❑ Silt Clay E] Peat Sandy Loam ❑ Clay Loam EJ Hardpan ❑ Adob Fill Material ------------ If yes, type __________________________ r (Plot plan, showing size of lot, location of sys elation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage t permitted if public sewer is apilable within 200 feet,} f PACKAGE TREATMENT [ ] SEPTIC TANKX Size---CQ_. _ .__ __`�_____________ __ Liquid Qepth __ �j k--- -- Capacity -1016PIIifTtiYp -------------------- Material-- ------------------- No. Compartments ------ Distance --- 'Distance to nearest: II _ � rp Ah__--Foundation _.__./®____-_____ Prop. Line ---�C ------- �.I9 LEACHING LINE K�No. of Lines __J------------ -------- Length of each line--yof__._----.._____- Total Length _yG-___--------•------- : �,. 'D' Box ------------ T ilter Material th Filter Material ----- -- -------------------- ------------ Distanc' to neares#:_..,, ell ____`""___-___-- Foundation _ - ------ Property Line ------------------------- SEEPAGE PIT [ ] Depth --- ----------- - - Diameter ---------------- Number ---------------------------- Rock Filled Yes E] No ❑ Waterble Dep h ----------------------------------------=-------Rock Size -------------------------------- °n Distance to eares - Well ----------------------------------------Foundation -------------------- Prop. Line -------------..... REPAIR/ADDITION(Prev. Sanitation Pe.. it ----_--------------------------------------- Date ----------------------------- Septic -_-____-___.___;_.---------Septic Tank (Spbcify Requirements) --------------------------------------- f ------�- t-•----------- - -------------------- Disposal Fiel I pecif q R uirements) �``� � © --- C �'-_ _� --_____ _ ei^^ ------------------------------------------------- -------------------- ------------------------ ---------------------- ---------------------------------------- ----------------------- (13 abw-existing and required addition on reverse side) I hereby certify that I have prepared this appl1rrlOn 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." Signed ___. 1 - Owner BY Title ------------- ------------------------ --------------- ------------ av (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B DATE 7._------ -- (----------------------- BUILDINGPERMIT ISSUED ----------------------------------------------------------- ------------------------------DATE _. ---------------------------------- ADDITIONAL COMMENTS ---------- -- ---------------- - -------- -------------------------------------------- ------------------------------------------------- -- - --------------- ------Z-------- -------- ----- --------------- - - -- -- - ----- o-- T . ------------ . tLFinal Inspection by; ----------------------------------- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 14 0 1_'AA Rau- SM