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FOR OFFICE USE: }� //37 APPLICATION FOR SANITATION PERMITc ------ ---------- ---- Permit No. .... ..... (complete in Triplicate) --------------------------------------------------------- This Permit Expires 1 Year From Date Issued 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: JOB ADDRESS/LOCATION r 1�QT__ 1/ 1±-3--____CENSUS TRACT __._ 0� - Owner's Name -------4_71ff/ f7-------�d s------------------------------------>-------------------------------------Phone ------------------------- ----•----- Address ----30�p 0O------X A_**sco!y------d--------------------- ............ City - rYA►G_l Contractor's Name -------4-'rAN__TIIi e�Vil__-----f_---S n{_________________________License # A4A'S 8A---- Phone . '. -3- Installation will serve: Residence ®Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:----/----- Number of bedrooms __/-------Garbage Grinder ------------ Lot Size J470 _X--/O o .............. Water Supply: Public System and name ________$t_, c__ �_C,---_ -- - -__---Private E]Character of soil to a depth of 3 feet: Sand [] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam R] Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type -------------_______________ (Plot plan, showing size of lot, location of system i ` relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepa pit permitted if ublic sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK [ Size__ _t'�___X_- -a__._______; Liquid Depth ___ ='______________ Capacity Pvo________ Type PY 64frMaterial__601#1C_`_. _ No. Compartments .!F-!................. Distance to nearest: Well ____�.�"'v _Foundation -__�a-r'_.___-___ Prop. Line ._�.�._..._... LEACHING LINE No. of Lines -_3X_ ------- Length eng hoof a ch l�e gth Total Len 'D' Box -----!____. Type Filter Materia a�4f�.� .•Depth Filter Material ______ _of ___________________________ Distance to nearest: Well ----fi__s.__.-_:----- Foundation --_- ©_�__-__-__-__ Property Line ....S.. ............. SEEPAGE PIT [ ) Depth --------- ---------- Diameter _______________ Number ___ ------------ Rock Filled Yes '❑ No 0 Water Table Depth ------------------------------------------------Rock Size ----------------------•--------- Distance to nearest: Well ________________________________________Foundation _____.-._-___--- --- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) t SepticTank (Specify Requirements) -------------------------------------------------------------------------------------------------------------T------------------•-•-------- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- --------------------------- ------------------------------------------------- ----------=--------------------------------- - - -----------------------------------------------•------ ------ (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, 1 shall not employ any person in such manneJ as to become subject to Workman's Compensation laws of California." / Signed _,en_AN73ow�K--- s-PoV---------------------- -----_------------ Owner L/ By ------ 4 ---- --w=----- -------------------------- ------------------------ Title ----- - ------------- - ----------------------------------------------- ( other ner /� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------I---1�_'�0--- --------------------- ------------ -------------------- ------------- DATE -------4' BUILDINGPERMIT ISSUED ------------ --------------------------------------------------------------------------------------------DATE ------------ ------------- ------------- ADDITIONALCOMMENTS --------- ----------------------------------------------------------------- ------------------------------------------------------------ -------- ----------------- -------------------- -----'-------- ---------------- -- - -- ---- ----- ------------ ------- ------ - ` - - ---- ------------------------------------------------ Final Inspection b - --- -- ------------------------------------Date ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1=' Rev. 5M ,.