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FOR OFFICE USE: APPLICATION FOR AANITATION PERMIT I� (Complete in Triplicate) Permit No,. /-3-r--- _7 �. This Permit Expires 1 Year From Date Issued Hate Issued _. .' _}`7-3 Application is hereby,mad e� 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/LOCATION1 '..____ "� P = C/ „ ,,, - ------.f� cf.� 4_(!;,.,CENSUS TRACT Owner's Name ------ ____41---4-----re 513-dI'."r,G ----------------------------------------- ---------- --------Phone Address ----- -------112.`"`fl !?"' � -- Cit Y ------------------------•---•- Contractor's I Name ------- - --/ . ------------------- - - ------------ ------=--------License # ------- -:-------------- Phone ------------------ -•------ ------ - Installation will serve; I Residence partment House❑ Commercial ❑Trailer Court ` Motel ❑ Other ---------------------------------- Number --------------------------------Number of living units:__ _��___ Number of bedrooms --______Garbage Grinder _____._-- Lot Size _.--_____---------------"____________-_-_-- a - Q4, Water Supply: Public System and name ----------------------------------------------------------------------- ------------------- ------------ -------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Ef--�ay Loam ❑ I Hardpan ❑ Adobe [❑ Fill Material ------------ If yes, type ---------------------------- (Plot _________-_________ - -(Plot plan, showing siie of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) y NEW INSTALLATION: (Nd eptk-tar�k o—seepage-pit-permitted-if-public,sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK:[ Size------------------------------------------------ Liquid Depth ------------•------------- 0 i ,Capacity- -------------� Type -------------------- Material---------------------- No. Compartments --------------------•- Distance to nearest Well _____________________ v --------------Foundation ---------------------- Prop. Line ------------------- LEACHING -- --LEACHING LINE [ ] = N6111 of Lines _ ---------------------- Length of each line---------- Total Length __________ ......... s ;,D Box ------------- Type Filter Material --------------------Depth Filter Material --------------------.------------ -4 ". _______---.-4 ,: Dis lance to nearest: Well ------------------------ Foundation ------------------------ Property Line _______._- ------- _. SEEPAGE PIT [ ] Dep�h -------------- ----- Diameter ---------------- Number -_______________.___-----_- Rock Filled Yes ❑ No ❑ ' 1 Water Table Deptht------------------------`_----��Rock Size ------ ------------------------- Distance ------------------------Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# - _?_________________________"-----________ Date __-"-_ _----______-__-___________} a; Septic Tank (Specify Requirements) ---------------I `------------------------------------------ ------------- Disposal Field (Specify Requirements) __-- '�_ _ - -�--�', -�: v ----------s '. �-.-rte t -- --------------------•--------------"---------- ------------------------------------------------------- il --------------"--- -------------)------- -- ----_- -_-- ------------- --I - ------------------------------------- I - ---------------------- J� (Draw existing and required addition on reverse side] I hereby certify that '1 have.?prepared.this application and that the work will be done in accordance with San Joaquire_,N- County Ordinances, State Las, and Rules and Regulations of the San Joaquin Local Health District. home owner or licen- sed agents signature certifiesMthe following: i "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner _t as to become ect to W kman's Co ensation laws of California." w0. Signed _ -iL .� - f ------------*----- ------ _ Owner ------------- --------------------------------------------------------- Ti ------------ -------------------------------------------------------- (If other than owner) IM FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.________-- - -- - -- - 3 ff -r-z-_.-`- ---- ------------------- - -----•---- DATE _". — - f1---- BUILDING PERMIT ISSUED _.�I-- ---------------------------------------- ---- ---- ---------------DATE ADDITIONAL COMMENTS ---!p__.____" - - -------------------------- - - ----------------------------------------- ---------------------------------------- :-------- "----------------------------- ---------- ----------------------- ------ - ----------------------------------------------- ------------------------------------------------ --------------inspection by: �� =-------------------•--'------- ------------------------------ Date _ _- _�'�� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 f-'68 Rev. 5M. i