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FOR OFFICE USE: � APPLICATION .FOR SANITATION PERMIT, (Complete in - Triplicate) Permit No: �s/-_ f_. _________________________ i This Permit Expires 1 Year From Date Issued Date Issued _L_`_ __ ,� 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 ._.A:��1-_-'---------11_05EE_PR------ 4----------A4`[CA-----------CENSUS TRACT ----- --- -- ---s---_--- Owner's Name ._.jFT-HF,__L-------- ? SJEZ�------------------------------------------------------- --------------------Phone ---- ------------------------ Address ------,3-57 ------J.Q_S_F-Pt* �------------ --------------------------- `. City J1`_ 7-CA----------------------------------------•------- -------- Contractor's Name ---- - --------------- ------------------------------1=:------.License # --------- -------------- Phone ------------------------------ ` Installation will serve: Residence �Ap`artment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other--------------------------------------------- Number ----------- -----'--------------------Number of living units:- l ------ Number of bedrooms _______Garbage Grinder L1f0`-_•Lot Size _ _____x---z2Y_____________ Water Supply: Public System and name -- f --------------------------- -----------------------------------------------------------------Private i Character of soil to a depth of 3 feet. Sand ❑ t5iIt❑ Clay ❑ i PeatSandy Loam er�Clay Loam E]an Hard p ❑ IjAdobeE] Fill Mate aIn!l If yes,type ___________________________ s (Plot plan, �h`pwing size of lot, Ioca'ion of system;�n relation to'ells, buildings, etc. must be placed on reverse side.) (,,` NEW INSTALLATION: (No septic tank or seepa I pit permitted if,public sewer is available within 200 feet,) v PACKAGE TR AT�iANT { ] SEPTIC TANK Size__ !t-_i✓------Y_- ------------- Liquid Depth _____,____ Capacity _____ Type. F19 1"�_ MaterialNo. Compartments ...... s f r Distance to nearest: Well ____ _____ ;_________Foundation V__--H--_--___ Prop. Line .... ------�`' LEACHING LINE [�o. of Lines ;_____��—_ "L'en }fi�rof-,each line______.?___._.--_--- Total Length _____1_. __�_-_-__ r r p 1� D' Box Type Filter Mater-plO_�--, ___Depth Filter �llaterial _-1._I_---------------------�______-_____. Distance to nearest: Well --�- Foundation ----- Property Line ------- SEEPAGE PIT [ ] Depth I Diameter si Numbe i 1 --- -:j----- L- ----- --------- --�-------- Rock Filled Yes ❑ No 0 Water Table Depth -- --..Rock Size --------------------------------- -------------------------- - i Distance to nearest: Well --------------- ---_-_---_-_- __.-------Foundation A---------------- Prop. Line .____.____--___-__-• E I ` REPAIR/ADDITION(Prev. Sanitation Permit# ---------------- __c+ ------- -------- Date _______________I Septic Tank (Specify Requirements) ----� -- ------------------------- -------------------------- Disposal Field (Specify Requiremer>ts) ___-_________ __ ________:__-t------------------ ------------------------------------------------------------ -------- ------------ `' ---�------------- I------------------------ #--------------------------------=------------------------ --.--- - ----------------------- ( raw existing and required dd4tio�on reverse side) I hereby certify that I have prepared this)applic6on pnd,th pt the wo Ill be done in accordance with San Joaquin County Ordinances, State Laws, and Rules andFRegula±fion's- of the San'Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following t3iA1�!�WQ "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 sub' ct to W kman's Compensation laws of California." Signed _11 � -�— � � I L --------------->--------- ------------------------------- -- Owner By --------------------------------------- -------------- ------------------------------- Title ----------------------------- ------------------ (If other than owner) i D FOR DEPARTMENT USE ONLY 7 APPLICATION ACCEPTED BY !-t1 `------rOX-------------------------------- DATE - BUILDING PERNRIT'iSSUED ji = _--�-. -T-DATEµ ----- --- --- . __ - - -- - - ------------ ADDITIONAL COMMENTS ----------------------- - - E — _- ----------------------------- -- _ - ---------------=-------------------------- ------------------------------------------------------ --� .3---.::i�, - � _. „ -Inspection ---------------- --- -------------- � �-�� ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M a