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FOR OFFICE USE. 1t ----- APPLICATION FOR SANITATION PERMIT � s------------------ (Complete in Triplicate) Permit No. 1__ ----__----- Date _ _Date Issued _________ _____-0 ______________________________________________________ +This Permit Expires 1 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/LOC l.9 7jf/� •--� /c /.l 1 -- - ------CENSUS TRACT --------r--�---------------- Owner's Name ------ ----Phone �!�__(p__--AV_,/------•- Address ------------- -- ------ -- -- -` � city Contractor's Name ----------- ---- --- - - ---- -- . -----------------License #16Q�/.1---------- Phone -�66_l ,07--- Installation will serve: Resid nce ❑Apartment H use Com ercia nTrailer Court i❑ _ a Motel ❑ Other -- - ---- - -- x - aj,� Number of living units:___:_____ Number of bedrooms ----_-_-.:__Garbage Grinder __.______--_Loft Size ----.______ ___ ____ ____________..__ Water Supply: Public System and name `�-------- -- ,----------------------------------------------` -----•---- Private ❑ ------------------- Character of soil to a depth of 3 feet: Sand❑--` `Silt fl-- Clay"°; Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes, type ---------------------------- (Plot ____._______--_E_______ __(Plot plan, showing size of lot, location of system-ih-relation to wells, buildings, etc. must be placed on reverse side.) - IN NEW INSTALLATION: (No septic tank or seepage pit ,lermitted if public sewer is available within 200 feet PACKAGE TREATMENT SEPTI K'[-}� � J $ize_ ----------- ------ Liquid Depth ----------- ci Ca at _ Type ------------------- Material--_ ---- No. Com - _- - Capacity Y ------- - --- Yp � --------------- Compartments __---- --------- Distance to nearest: Well ___________________________________Foundation ---------------------- Prop. Line "_...........__-._____- LEACHING LINE No. of Lines -------- ------------_._____ ____ Length of each line-----r_`�__'6_._____.______ Total Length -----9'Q.---------------- 'D' Box ------- __._ Type Filter Material _ -----Depth Filter Material --- �__��________------______._.__ Distance to nearest: Well ___-JOW -� Fo n ationl .___/� -r_________- Property Line __/C'__--______._.___ ¢i SEEPAGE PIT Depth ---AS - Diameter X3________ Number -]------ - #- ------- .�_"____ - Rock Filled Yes lz No ❑ � Water Table Depth ------------------------------------------------Rock Size Distance to nearest: Well ------ CJS__________________Foundation ---/t4---------- Prop. Line ------/0 ___ REPAIR/ADDITION(Prev. Sanitation Permit# ."-_- ___._______.___ Date ________________ ___________ _ Septic Tank (Specify Requirements) --------------- -- ---G.. - _ --fd t)V P Disposal Field (Specify Requirements) ---------------------------•---------------------------------------------------------- ------ ----------------- •--------------- -----------------------------------------------------------------------------.-----------.- ------------------------------------------------------------------------ --------------------------- (Draw existing and Tequired addition on reverse side) I hereby certify that I have prepared this application anil that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and.Rej6l+ations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: 1 1 M 1 "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner peati as to become subject to Workman's Comnson laws of California." Signed ----------------------------- --------- Owner SY ---------- - f - ------------------------------ Title �} (If -_ an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------- DATE 7D_' - ----- ---- - BUILDING PERMIT ISSUED / DATE -------- AD ITIONAL� COMMENTS .. i : qJ =1n/C.�..ei _ Yar$ '� �. .a d �3 ------------------------ --- i- - ---------------------------------- Final Inspection by: ---------- _ --- -----------Date ---A�_ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M