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FOR OFFICE_ USE: APPLICATION FOR SANITATION PERMIT ------------------------------------------------- [ (Complete in Triplicate) Permit No: --7_.-----_-_-._". �----------------------------------------- 4f w:� 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 incompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIONCE C Q----.%1x}V/�� ------------ NSUS TRA T --------------------• l Owner's Name ------- --------_-Phone Address ---J461-Q - _ _�Q- it �} Contractors Name -- ED-__-COnfnl )�S C --=--- --- -------------------- __ - v V= 1 --J:--- -- -- -------- - �---------- -------------- -----=-- - ! ' =---- Phone ----------------------------•- _ - --.License #'---;�----- -_-- Installation will serve. Residence ❑iApartment House❑ Commercial.❑Trane"r Court Motel [j Other --- �j - Number of living units:--- -_-.-- Number of bedrooms .L-_-_Garbage Grinder __-- Lot Size _ __ _C_�- _ ' _._ . ------- Water Supply: Public System and name ----------------- ---- --_,------_---- -, - ------------ -------------- - -------•- ---------=`Private ©� Character_of soil to a depth of 3 feet: C�Sand' Silt Cla / a z ` ❑ y ❑ Peat Sandy Loam ❑'\,Cllay Loam .❑ „ Hardpan ❑ Adobe [] Fill Material If yes, type ------- -------------- (Plot ----_- ---_______(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on(-reverse side.) U NEW INSTALLATION: (No septici'ank or seepag it permitted ifpublic sewer is available within 200 feet,) I r PACKAGE TREATMENT [ SEPTIC TANK pr Size-f-_XJ` _X__S _:` � Li-uid De the � __-_/ - Material�COAfC 3-( - q � p , ~ Capacity 1-._d----____-- Type -faUl-;_�D - _ �.o. Com }artments stance to nearest: Well __-.--_. ___" --___ - t f l Foundation _��- I�� ___ Prop. Line -`�}�_ -------- LEACHING - LEACHING LINE [ No, of Lines ----- Length of each-line-It ___�-__,'7t/.__ Total Length �------1 D 2 2 ' 'D' Boxy,�_S_ Type Filter Material Q Depth r ' Filter( Material - r 1 Distance to nearest: Well _----�___f7t= Foundation -------- Property _ p rty Line ------------------------ SEEPAGE PIT [ ] Depth ------- ------------ Diameter ---------------- Number ---------------- Rock Filled Yes ❑ No ❑ I i WateATable) Depth ------------------------------------------- ------- Size--------------~__- _ ---------------------------- - - Distance to�nearest: Well --._----------------- Foundation ---.---_ ,_-fic--- .Prop. Line ---.--.__--_.....--_.. a —A--)I (;s 1 REPAIRJADDITlON lPrev. Sanitation Permit# -------------------------------------- ---- Date -------J-__-_------ --- ' ----] Septic Tank (Specify Requirements) --------------------------------------------------- = - f`` �, i - -------------- Disposal Field (Specify Requirements) ------------- ---- -- ' --- ------------------------------- ---------------- ------ --- ------------------------ ------------------------------ --- -.� ----- --- r ------------ ---------------------- 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 Joaquin County Ordinances, State Laws, and Rules and Regulations of the Sa'n Joaquin Local Health District. Home owner or quipicen- 7 sed agents signature certifies the following: "I certify t a in fi e performance of the work for which this permit is issued; I shall not employ any person in such manner as to bec subj ct to or man's Compensation laws of California." �- Signed --V ------- Owne'r, �. By ------------- ---- --- --------- - ---- } -'------ ---------------------------T7SRcd Titfe - ------------- ----------------------------- ----------- (If other than owner I� F ��. � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------__-'- ----E- --- ------------------- ------------------ DATE -..---- ---_n/ 7 ` BIJiLD.ING_PEI2MIT-ISSU.ED=_------------- -- - = r — -SATE --�--- ---� :_ . ADDITIONAL COMMENTS ------------- - ------------------�-------------- - -- .�: ---------------------------------- - i�- ----------- --------------------=---- _- ---- - -- ---- ------ - =-_ ____-��.----- ------------------------ - - -------- Final Inspection : _.-- - ----------------------- ----------.Date ----- ----- -------------- SAN - --- ----- -SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68"Rev. 5M