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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------- --- ---- - --- - 7 .-s; ,b (Complete in Triplicate) Permit No_ ______ ___________- ---------- ------------------------------------------ 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 .2A-1-5-1 f. 1) g od � -- J _ --------------------------CENSUS TRACT -------------------------- G Owner's Name ---------------// o are-------vl Pho/ne --. . ---------------------------- _ glZ 575�� - --- -- Address -------------- '``E ----------------------. City -------------- ----------------------------------- I� Contractor's Name ----- ------ -- --- -------- ------ ------.License # --- �----- Phone -----------------•-- I Installation will serve: Residence ❑Apartment House❑ Commercial:❑Trailer Court ;❑ Motel ❑Other ------04Z I ----0Q.r ti s Number of living units:��'- Number of bedrooms .--.__-__-_-Garbage Grinder -------- --- Lot Sized -------------- Water '.! .______Water Supply: Public System and name ----------------------------------•--------------------------------------------------------------------------:_Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan Ukr Adobe.E) 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 INSTALLATION: (No septic tank or seepage pit permitted if public r isyvailable within 200 feet,) / k PACKAGE TREATMENT f ] SEPTIC TANK'[ Size'Z��_ --- -----S 6quid Depth __.---_-_--- Capacity -00.�s_�------ Type Material No. Compartments --------R----------- Distance to nearest: Well -------;:1 _----------------Foundation ----f------------ Prop. Line -_�__IQ_......-_ LEACHING LINE No. -of Lines •----------I------------ Length of ,each line_______34_______________ Total Length ----3-4--------------------0 D' $ox ._____.;__. Type Filter Material$ l_�c--[`oc�< Depth Filter Material -----------I-7----------------------------- { Distance to nearest: Nell _:-_.�.1.OQ-_.-_- Foundation .___26..___-__-- Property Line -__->,S_ _:____ SEEPAGE PIT Depth #X I,2_YJO Diameter, ------- ------ Number ------------! ------------- Rock .Filled Yes 0' No i❑ �. ----------- Rock Size _s�� '� ��c•� Water Table,Depth L } Distance to nearest: Well --------------------Foundation ------ ----- Prop. Line ..._S_4----- REPAIR/ADDITION(Prev. Sanitation Permit# ---------------_----------------------------- Dpte ----------------------------------) o Septic Tank (Specify Requirements) -------------------- 9• T Disposal Field'(Specify Requirements) --------------------------------- ----------- ------------------------------------------ ------------------------------ ------------ - - - ____________ -------------- -----_--------- _-----__-----" r .____--------------_-.----------1__------ -- ------1-----.--------------------------- ---------------------------------------------- (Draw existing --------`----------.-.-.----------------------------------------.------- (Drawexisting and required addition on.reverse side) #k I hereby certify that I have prepared this application and that theworkwill 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, I shall not employ any person in such manner as to become subjectt Wor m's C ensatton laws of California. r _. Signed �i�. G+�� - Own'er• By -- ---- --------------------------------------------------- Title - i (If other than owner). x FOR jDEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... . ------------------------------------------- -_ DATE ..__�.3�. -----_T_3---- - BUILDING PERMIT ISSUED _-: �,. _. ` `� = -DATE ------ ------------------------ ADDITIONAL COMMENTS ------------- -- ------------------ ---------------------------------------- -------------------------- ------------------------------------------ ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- - -- ------------------- ----------•-----------.-- - - - ------ ----------------------------- - --------------=------- ------ -------------------- ------------- Final Inspection by: ------------------ql+ - °�'� ------------------------------------- ---------------------Date -------/.l�5. -7- ------------------ f 5 JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M