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n FOR OFFICE USE: \_/ APPLICATION FOR SANITATION PERMIT ------------------------ --------- (Complete in Triplicate} Permit No. ________ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the Son Joaquin Local Health District for a per 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 rou ------Il19FF ------ t ,If_-D_ -----_CENSUS TRACT ---- -`-�/---- j� --------------- -------------------Phone ------- ------•--------._ _._....._ Owner's Name --------- OIh-------._17R�._�_�K_�_�_'--------------------- Address -----------p2v� ----�0x.------- ---t!/-L?_ - �\{ City -Y!A _(I----------------------•-----•--- -------•-- Contractor's Name '- License # Phone ---------------- Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ❑ ` S 1,. Motel ❑ Other -------------------------------------------- A Number of living units:--- 1_ Number of bedrooms _-..3.c'__.Garbage Grinder ��__._ Lot Size _AC - ------. --_ Water Supply: Public System and name ----------=------------------------------------------------------•------- -----------Private r[ ' 4 Character of soil to a depth•.of)'feet:_._.Sand'❑ iSilt❑_ Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑ (�, j Hardpan ❑ Adobe ❑ Fill Material __0 If yes, type _____.____________________ V {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 seep pit :permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK 1Size_--- _ ��_.a`__ ^.___________ Liquid Depth ____T�_..___. Capacity _1 o--------- Type _1 E_f. Material-�"P__1 et�T No. Compartments ----'�.--�... . i Distance to nearest: Well --------t?0---_ `___________Foundation -------- Prop. Line -- 7 01 - �LEACHING LINE No. of Lines ---- -_____ ----- Length of each line- ------- ------ Total Length *-_...-- D' Box,y�5_ Type Filter Material __f��_G _Depth Filter Material -_-_--_I9___�`__---_. ..`_____._.__._ Distance to nearest: Well - __ `__-- Foundation--_A! __ ---- Property_ Line __•{?__._-----_-_.-__ SEEPAGE PIT [ ] --Depth ____________________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No 0 'l Water Table Depth -----�----- Rock Size --------------•------- -- ------.--- fistance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -----------.__....--.- REPAIR/ADDITION(Prev. Sanitation Permit# ________________ __________________ Date ----------------------------------) Septic Tank (Specify Requirements) f Disposal Field (Specify Requirements) ------------------------------------------------------LL----------------- --------------------------- ------------ ____________________________________ ------------------------------------------------L------------------ _ _ _ _ ___ _ (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 San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify in he performance f th work for which this permit is issued, I shall not employ any person in such manner as to b s ject to ma s C pensation laws of California." Signed ---------- Owner' I By ---------- ------------ {------------------- -_------------------ --------- Title Title --- ------------------------------ -------- ------ -(If other fhan owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- f fl-L f ------------- --------------------------- DATE __=:/_�21_-_7 � BUILDING PERMIT ISSUED ------------------ ------------------------------- - --------------------------DATE ------------------------------ ------------- ADDITIONALCOMMENTS --------- -- ----- ------------- - -----------------------------------------------------------------------------=-------------------------- -------------- --------------- ------ -------- -------------------- - ---------- ----- ---- ------ -------- ---------- --- -- - -------------------------------------------------- �. `d Final ins ec Date ___________ __ p SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M