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FOR OFFICE USE: APPLICATION FOR SANITATION 'PERMIT --------- -------- Permit No: (Complete in Triplicate) Date Issued l ' This Permit Expires l 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: JOB ADDRESS/LOCATION ._��f�. - �_��,�U------)010--------------- --------. - , -- CENSUS TRACT -------------- ....... Owner's Name -� ......P-1-7' -�A�1_---------------------- ------------- ---------------- -------Phone ------------------------------------ .529 .------ ----------------------------.City :: _ --- ----------------------------•-- Address __ -"-"" - -------------------------------- i Licenser#..1_Z7-_�G __ Phone ' Contractor's Name _, - ---------� ` _ Installation will serve: Residence p"partment House❑ Commercial ❑Trailer Court i❑ it Motel ❑Other -------------------------------------------- € Number of {wing units:_--�_____ Number of bedrooms ""�.----Garbage Grinder ------------ Lot Size ��T---�- --1-��- ----- --------------------•----------- ----------------- --------------- Private �'— Water Supply: Public System and name __-___r______ --------- --"---""""-�"""--" - - Character of soil to a depth of 3 feet: San-d' � Silt❑ Clay ❑ Peat❑ Sandy Loam -El Clay Loam;❑ (Hardpan ❑'' 'Adobe-9T- 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.) I k NEW INSTALLATION: (No septic tank or seepage;pit permitted if public sewers available within 200 feet,) SEPTIC TANK; Size = Liquid Depth ----------------------••- PACKAGE TREATMENT [ ] [.] Capacity - Type -------------------- Material----------------- ---- No. Compartments -----------•-••- ---• Distance to nearest: Well _________________________ _ Foundation ------------------ Prop. Line --- •-------- LEACHING LINE [ ] No. of Lines ------------------------ Length,of each line---------------- Total Length ~ 'D' Box --- -------- Type Filter Material --------------------Depth Filter Materia! -------------------------------- Foundation -----------------------------4 = �I Property Line Distance to nearest: Well ------------------"- --- Foundation ____,------------- ---- P tY ' ___ Rock Filled Yes No SEEPAGE PIT [ ] Depth Diameter ---------- ---- Number --------------------- ❑ ----------------- t Water Table Depth Rock.Size -------------------------------- Prop. Line Distance to nearest: Wel! ------------- �-----------------Foundation -----------------7- , iDat -------------------------------- REPAIR./ADDITION(Prev. Sanitation Permit# ------------- ---- - -----------------�,•,. -- e� r x r C h/A/.i!'------ Septic Tank (Specify Requirements) ____- �___.�--�-�--�^-:.;;-!7r-; Disposal Field (Specify Requirements) -------- -------------------------------- ------------------------------------------------------------- --- --------- ------------- ------------------------------------------- ------------ - t------------ ------------------- --------------------------------------------------------------------------------------- ' (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 .lo tquin ' 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: 1 "€ 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 beta a subject to Workman's Compensation laws of California." Signed _:�_ ,..ham _ ------- -- I � --------------------1 T------ Owner -------------------------------------------------- - Title -- ------------------- (If other than owner) ;' l FOR .DEPARTMENT USE ONLY �•- 1 7�l�G ) DATE ---EJ '------ 7---------•---- APPLICATION ACCEPTED BY .'f-- —4 Yaa---u� -- ----------•---------------------"-------- DATE - BUILDINGPERMIT ISSUED ---- ------`--------- ----------------------------------------------------- ADDITIONAL COMMENTS -----------!--------------------- i --- _ _ __ _ _b____________________________________________ yi ___..._____________________________________ __------------------------------------------------------------ -_-______- ____-____-__.___---_______ ____-_______________ - - ___.__--_-________--___-____---__"_______-__________-- - t __ ______ -- -- -- ------ Date - --------- -- Final Inspection b SAN --- --- --- - -• -------,-- Date JOAQUI ' LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M. .