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FSR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ---------------------------------------- ---- Permit No. (Complete in Triplicate) .. -------------------------- ----- ----------------------- -_ ; _ ---._ _ __-----__- ------ -------- ------- Date Issued .�.`_Z- ------ This Permit Expires 1 Year From Date Issued ' it. 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 complia�nnce�with County Ordinance No. 549 and existing Rules and Regulations: , JOB ADDRESS/LOCATION .__ <__. -------h'._ --------As (:1/.__---- _.CENSUS TRACT -----------____----------- Owner's _______ __Owner's Name G o--'---4` ------------------ --------- -----------------------------------------P h o n e Address �JaC. ---------------------- = City. CX ---------------------------------------------- Contractor's Name . --- ------.License # _ -- - ------- Phone s3'�4�► _ ---------- Installation will serve: Residence ❑ Apartment House❑ Commercial:❑Trailer Court ;❑ Motel ❑ Other .&T�A---J?4tKc--'.. Number of living units:L3---_ Number of bedrooms _ ____Garbage Grinder _M,0' tot Size .___________-__________________ --------- Water Supply: Public System and name -------------=---------------------------------------- ---------------------------------------------------------Private, Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat Sandy Loam 0 Clay Loam.E] Hardpan ❑ Adobe ❑ Fill ;terial ------------ If yes,type ____________________________. " (Plot plan, showing size of lot, location of system in relation to IIs, buildings, etc. must be placed on reverse side.) NEW ACKAGEATREATMENT {No sSEPTIC TANK] page pit permitted ifli sewer is available within 200 feet,) f --------- Liquid Depth -----�--------------•- Capacity _1Z�_I-/ Type ---------------- Material---------------------- No. Compartments ------�� _.f-..---� Distance to nearest: Well � '_- _ .-_ /tIf^0___-___.Foundation _/Z5- ----------- Prop. Line _-_�_D........... LEACHING LINE No. of Lines ___ _______________ Length f each line-------yU_!----------- Total Length _/_W_1______________.. D' Box ________ Type Filter Mater1b1 __Depth Filter Material-_12_________________________________ ~ Distance to nearest: Well _____________ ______ Foundation ---------------- Property,Line --------....__-_--__ SEEPAGE PIT [ ] Depth ___.---- --_--- Diametet _______________ Number __ _____________ Rock Filled Yes [] No ❑ <. Water Table Depth --------------- - - ---------------------------- Rock Size.-------------------- ------ Distance to nearest: Well - ---- -------------------------------Foundation -------------------- Prop. Line -------------_------ REPAIR/ADDITION(Prey. Sanitation Permit ._ __.___________------------- Date ________.-.--...._.--------_______) Septic Tank (Specify Requirements) ------------ ------- -- ---------------------------------------------------------------------------- �.._ ,. Disposal Field (Specify Requirements) ____ __ _ --- ---11/ e�-------- tz----W-1 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- [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." Signed _ --------- Owner k) BY --- r`_ Gt----------------------- - �--------------------------------------- Title (If ofiher than owne R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --------------------------------------------- DATE --2-2 1--------------------- BUILDING PERMIT ISSUED -- - ---------- --------------- ------------------------------------------ ------- -----DATE ------------------------------- -------=- ADDITIONALCOMMENTS ------ ------------------------ ------ - ------- --------------------=----------- -----------a------ - ------------------------------------------------- ------------- -- - ---------------- --------- ------- ---------------------- - -------- - ------------ ----- -------------------- --------------- ------------------------------------------- -------- -- - ---- --- -- ---------4_1 --------------- -- -------------- -- ` Zv------------------------------------------ --- -- - --------------------------- -- -------- -------- -- - -------- -------------------------- -- --------== ---------------------=------- FinalInspection by-- ------------------------- '=' --------------------------------------------------------- ---------------------- e - ----- ----- SAN�JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �'`