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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' ------ --= ----------------------------------------- y�-I Permit No.. 7 3� (Complete in Triplicate) --------------------------- ' Date Issued y ---------------- -- _-----_--. This Permit Expires 1 Year From Date Issued <k Application is hereby made to tl San Joaquin Local Health District for a permit to construct and install the work herein t described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations:, JOB ADDRESS/LOCATION moi____ __ a XI___612___- -_ CENSUS TRACT ---------- Owner's __Owner's Name �sr ------U01Vlll4;ejV1 te ----- - -------------------- ----- -------Phone 1 Address --- R_r$-.1r6f . -------------------------- -- ------------ City ---- r-pA- - Contractor's Name --- ------- _ ________ _______License # -------------- _ _ --- ---_ Phone ------------..__-_ serve:Installation will see: Residence ❑Apartment House'❑ Commercial ❑Trailer Court ;❑ Motel 0 Other-------------------------------------------- �+/ Number of bedrooms .../.......Garbage Grinder --------- Lot Size 114°_X-__15 _____ Number of living units:_/_______ Water Supply: Public System and name ------------ ------------------------------------------------------------------ ------------------1._--__• _______Private4_❑ Character of-soil to a depth of 3 feet: Sand Silt❑ Clay Peat❑ ` Sandy loam ❑ Clay Loam;D _ - W ' Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type _-_ __-_,-.------___ ___(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INST/LLITION: (No septic tank or seepago pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------------_------------__ __ _______I_______ Liquid Depth __-_________________-_____ Capaciity ----------- TYp -------------------- Material--- -- ------------- Na Compartments ...................... Distance to nearest: Well ------------------------------------Foundation __-_'.-------- ------ Prop. Line ...... (N LEACHING LINE [ ] No. of Lines __ ___________ __ _ Length of each Fine----------------------- _ Total Length ____ O �. ` 'D' Box ----- -_ Type Filter Material __________________Depth Filter aterial -------------------------------------------- Distance to nearest: Well . ______ ___________ Foundation --------------- -------- Property Line ......................... SEEPAGE PIT [ ) Depth _- _______________ Diam er ________________ Number ________________ _- Rock Filled Yes E] No C] Water Table Depth ----------- ----------------------------------Rock Size -- -- -------------------------- Distance to nerarest: Well ____ __________________________________Foundation :_:.___ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit#--------------------------------------- ----_ Date _____________ --------- :.;f -Septic Tank (Specify Requirements) = - --5--- rte" -------- - - - - - �----- Disposal Field (Specify Requirements) JV -� ------- (------- = -------- -- ----------------- ------- -- -- -- �l_---- -------- ----------------------------------- ------------------------------ --------- '" ------ --------- ------------------------------------------------------------------------------- --- -------- ........... - (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.: dinances, State Laws, and Rules and.Regulations of the San Joaquin Local Health' District. Home`owner or licen- sed agents signature certifies the following: "1 4ify that in the performance of the work for Which this permit is issued, I shall not employ any person in such manner as to beasrn0 sub' o ork n's Compensation laws of California. Signed ..t : . Owner ------- ------ BY :- ------------------------------------------ - ----• ----- --- Title ----- ------ ---- ------ --------- - (If other than owner) FOR DEPA1117 T USE ONLY APPLICATION ACCEPTED BY-_---__I_7t[1'4 :- ------ R�--•--, - E--/Y`-C---------�^"tJ�JO_ DATE ----BUILDING PERMIT PERMIT ISSUED - ------ --------------------- =- DATE ----- ---- -- -- ------- - ADDITIONAL COMMENTS -- --- ------ ---- ----------- ----------------------------------- ----------- -- -- --- ------- - -4-- - --- --- ----- - -------------------------------------------------------- f _. Final Inspect! ------Date ---- ----------- ----- SAN JOAQUIN LOCAL' HEALTH DISTRICT E. H. 9 ?lr 6B g M ,•.