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FOR OFFICE USE: �. U APPLICATION FOR SANITATION PERMIT i (Complete in Triplicate) Permit No -------- • i CC IF ---------------------------- This Permit Expires 1 Year From Date Issued Date Issued f 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. iz � st rt17}± ! r JOB ADDRESS/LOCATION �_ . + T _ ?'- - �-Is 7q ---------------- ----CENSUS TRACT Owner's Name --/-q I... .t 4/W alp --------------------------------- --------------- -.-Phone Address ---------- ----------- ------------------------------- City 'r�ILI/h� ----------------------------• - -- Contractor's Name _./V'L-J 7:''- ---------------------------------------------- --------License #17708 3------ Phone 44415�.F'p?—46 Installation will serve: Residence?4-Apartment Nouse,❑ Commercial :❑Trailer Court i❑ Motel ❑ Other Number of living units:----�._ -, Number of bedrooms ____1------Garbage Grinder -- _ Vd_._. Lot,Size _._ --_-- -.--- Water Supply: Public System and name _______________ -------- - -.-_-----__------------------_---------_----Private ❑ - - _ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam [7�'Clay Loam ❑ 0: Hardpan ❑ Adobe ❑ Fill Material ----------- If yes, type ---------------------------- (Plot -------_._.- _ - (Plat plan, showing size of lot, location,of system Sin relation to wells, buildings, etc. must be placed on reverse side.} Oq NEW INSTALLATION: (No septic.tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[4, Size �' re ✓ Y� ' --------------------- Liquid Depth - -------------... J�J Capacity ly2dlJ �c-- Type,97A&Of aterial_edf� �L"7 No. Compartments _ ................. Distance to nearest: Well -----------------------Foundation �—~ -------- -----------Foundation ----10------------ Prop. Line = -------------- LEACHING LINE [41--No. of Lines ----/------------------ Length of each line-----. ---- Total Length ----- ------------- D' Box ./YO---- Type Filter Material Depth Filter Material ___ ---------_--------_-------------- ? ll Distance to nearest: Diameter amete�._r____ -----Foundation © '-_.______ Rook Filled in Yes No Water SEEPAGE PIT [ j Depth -------------------- ❑ Water Table Depth ------------------------------------------------Rock Size Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop, Line -------------- REPAIR/ADDITION{Prev. Sanitation Permit# ----------------------------------------I_ Date t--- -_--_-------------------------1 Septic Tank {Specify Requirements♦ ____________________ --------------------------------------------------- - -- Disposal Field (Specify Requirements) ______ ---------------I---- --------------- --------------------------------------------=-------------------------------- ------------------------------------------- raw existing and required addition on reverse sidel I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State taws, and Rules and Regulations of the Sun 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 becom subject to Work an"s Compensation laws of California." Signed ---- --- -- ---- -------------------------------------------------- Owner ------------------- ---------- By -------- ---------------- --------------------------- ----------------- ------ ------. Title ------- -- --- (If other than owner) -------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE ..J f /' BUILDING PERMIT ISSUED --------------- ----- -------DATE ---------------------- - ---_ -- ------------------ ---------- ------------ - - -- ----------------------------------- -- - - ADDITIONAL COMMENTS ---------------- ------------------------------------------------------ --------------------- ----------- t -------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------- ins ection b - ------------------------------------------------------------------- Final -- ---- ----- p Y ----- ------------------------------- ----Date ' --------- ----- r SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M.