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FOR OFFICE USE: -7 k APPLICATION FOR SANITATION PERMIT Permit No, z/-l'-f / -7---------------/------------------ - - .I .I (Complete in Triplicate) ---- ------------------------------------- --------------- . - .5*1 \1- . k A This Permit Expires I Year From Date Issued Date Issued ---------------------------------------A ------------ 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 ce with Coynty OrdiVnce No. 549 and existing Rules and Regulations: -�"ur` JOB ADDRESS/LOCATION ---------------------------------CENSUS TRACT -------------- ----------- ---------------6-------------- Phone ------------- - -- ---- -- -- ------ -- Owner's Name ------------- 74V --- -------------------------------------------- --------------------- W-�G07_ Address ------ - -- ---------- �-P:�7�- .License -------- Phone ------=------------ Contractor's Name ------- t- rc Trailer Court serve: Residence Apartment HoIuse f] Ccimme icil f -] Installation will e: Motel F-1 Other ----- •----------------------- I I 7>-L.1-1 1 -t -4 c�- Number of living units:---f ----- Number of bedrooms -- ----Garbage Giriniclel'.--- Lot Size ---9-0---I(Ijg-nA------------ Water Supply: Public System and name C-A-------"-:, --------Private 7 -------------- ------------- ---------- --------------------- ---------- i t : I -E] Character of soil to a depth of 3 feet Sand'E] Silt F I Clay E] Peat F] I Sandy Loam ❑ Clay Loam Hardpan E] lAdobex Fill Mciteriall ---t---- 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 . kjJ�L i J 'AQ . I . NEW INSTALLATION: (No septic tank or-seepagg it perrnittediif.public sewer is available within 200 feet.Jif 1 ------------ PACKAGE TREATMENT SEPTIC TANK![ Size------------------------------ ----- liquid .Depth --------------------------- Capacity -------------------- TYPE -------------------- Material------------- -------- No. Compartments ----------------- Distance to nearest. Wellf------------------------------------Foundation ----- ---------------- Prop. Line -------------- --------- LEACHING LINE No. of Lines ------------------- ---- Length of each line--)�------------------------ Total Length --------------------•-------- 'D' Box ------------ Type Filter Material --------------------Depth 'Filter Material --------------- ----------------------- Di sto nce-to-nea rest: Well'------------------------ Foundation ------------------------ Property Line. ------------------------- I I .i I I SEEPAGE PIT Depth- -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes :F No [3 FWater, Table Depth -1-------=----------------------------->--------Rock Size -------------------------------- Distance to nearest. Well ---------------------- -----------------Foundation ----------- --------- Prop. Line ---------------------- - REPAIR/ADDITION(Prev. Sanitation Permit s# -------- ----------------- -]------------- Date -------------------- ----------- Septic Tank (Specify Requirements) ------------- - -- -------- -------------,--------------------------- I - ---------- -- Disposal Field (Specify Requirements) I ?-944 -- ---------------------------------------------------------- /1 X LS - ---------------------------I------------------------ ------------------------------------------------------- ........... ------------------- ------------- --------------------- ----------------------------------------------- ------------------------------------------------------------------------------------------------- (prp�y.exi_sfing2ncLrequirecl,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 Son Joaquin Local Health District. Home owner or licen- L sed agents signature certifies the following: "1 certify that in the performanceaf 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-' e r --------:—---------------- ---------------- -------------- BY -------------- - --------- T,C'2 --------- ----------------------- Title ---------4 - ----------- ------------------ ---------------- (I oth bn oned FdR,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- r-e-j - - -.14------------------------------------------------- DATE ---- ---------- BUILDINGPERMIT ISSUED ---------------------------------------- -----------------------------------------------------------------DATE ------------------------------------------- rADDITIONAL COMMENTS ----------------------------------------------------------------------------------------------------------------------------------------------- --- ------------------ --- -------------------------------------------------------------------------------------------------------------------------- --- ---------- ---------------------------------- ----- -- -------��;---- -- ------------------------------------- ----------------------------------------------------------------------------- ------------- - ------------------------------------ ------------------------------------------------ -----------------------------------------------------Date ---------- ---- ------ Final Inspection by: --- ----�e ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,