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G - ' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------- Date � 77� -------------- - -- Permit No. - - •- --' (Complete in Triplicate) - - Date Issued ---_'-_- This Permit Expires ] Year From 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: JOBrADDRESS LOC TION .- --------------------- -3Ta r L--`- JG', cF --------`- CENSUS TRACT /1 - Owner's Name ----- -------� ------------------------------------------- -------Phone ------------------------------------ Address ------ - ------ --- - ~3 'a -- -� - ` f r City -----•------------------------------------- Contractor's Name __ I� P �_,-----••-- --------------- --�partment ----------------- ----.License #.��-,��--- hone yG �--- Installation will serve: Residence House❑ Commercial ❑Trailer Court ;❑ I Motel ❑ Other --.-.---_.- Number of living units:_.---- --.- Number of bedrooms----_----Garbage Grinder e __ Lot Size&.3_�__X__ �-__._._...__. --- Water Supply: Public System and 'name ----------------------------------------------------------_------------------------------------------------------Private Character of soil to a depth of 3 feet:, Sand ❑ Silt❑ Clay Peat ❑ Sandy Loam [) Clay Loam '[] I� v--Hardpan ❑ :� Adobe Fill Material ,111____ If yes,type ___________________________ (Pli�t plan, showing size of,jlot, locution of sy3tem in relation to wells, buildings, etc. must be placed on reverse side.) \ NEW INSTALLATION: (No!!Iseptic tank or seepcig it permitted if public sewer is available within 200 feet,} PA3CKAGE TREATMENT [ !r SEPTIC TANK'[ Size-- ------------ C � -------------- Liquid Depth -----_------_ Capacity ----- -- Type C Materia _Y1�JL _ No. Compartments _...."J . ! ----------- 11 s once .to nearest: Well,--___--_ 1________________Foundation _.- _-�_________ Prop. Line-�__-_-:--__..._ C lj LEACHING LINE [ No.1of Line`s --------------- `_-__ Length of ch line_ ------ Total nc�th l_-1- _- -_---_---_-__-_ 61, D' Box - _ Type Filter Material Poch Filter Material _�-- --------------------------------------- istance o;nearest: Well ___�I_________ Foundation ln_----------------- Property Line ___cy f SEEPAGE PIT [ Depth -'�>5---___-___ Diameter __-3.3____- Number _._-__ _-_-_.-__-- .Rock Filled Yes No �' 1 r Water Table-'Depth. -= `t --- -r----------------------------Rock Size �f2=------------------ r i dD t Of / - Distance to netrrest: Well -------1-------------------------------Foundation --�---- Prop. Line - - Distance REPAIR/ADDITION(Prev. Sariitbtion Permit#t-------------------------------------------- Date ___----_------_.___-..___..-._____} Septic Tank (Specify Requirements) '---------f- --------------------------------------------------------------------------------------------- •--------------------------- Disposal Field (Specify jaRequirements)' ------------------------------------------------------------I-------------------------------------------------------------------------- i � .�„ �. � . r I� A -------------------------------------- -----------------------------------------------------------I----------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 li reby certify that I haveprepared this cpplication and~thaY4tthe 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 iignatore certifies the following. j "t: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 Cofnpensation laws of California." Signed = _ _ Owner _?. .. 11' W. ,� By: ' - ------------------------- Title ------- l -_.-Y -t/_.----------- t (If other th owner) FOP DEPARTMENT USE ONLY APPLICATION ACCEPTED = - -------------------------------------------- DATE `' ��--------------------- t _ . -BUILDING PERMIT ISSUED . °`-------------------F---------------------------------------- ----------------------- - --------DATE ------- ------- --------------------------- ADDITIONAL COMMENTS _-w-. I-------------- ------"----------------------------------------------- --------------------------------------- --------------------------- -----)------------------------ - -w---- I - it - ----- ------ --- Final Inspection b _----------------------- ate ---- e-n-1-`�=--�- -_J- p Y - SAN JOAQUIN LOCAL HEALTH DISTRICT E. Fi. 9 9-'68 Rev. 5M �. -� 44