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FOR OFFICE USE: APPLICATION FOR SANITATION,PERMIT d ` ------------- --------------- ----- ----------------- .`44, (Complete in Triplicate] f ------------ -- i --- -----=------ -------------- Date Issued This Permit Expires i Year From Date Issued ---. - .y with Count Ordinance No. 54� a Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein nd4xisting Rules and Regulations. 1 n cfmpliance, Y, - r�{ described. This application is•ma e i prss'�xt=c.�� CENSUS TRACT �-'�`'s-'�-------- • pP _ JOB ADDRESS/.,LOCATION ---------- Owner's Nam;1V ✓/ S-- -------1�--' C, itY _4i ------------------ ------ Address -------- �? -1 l ` -- License # ------------ ------------ Phone ------------------------------ Contractor's Name --- ---- - --- --- --------------- ------- Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court t Motel ❑Other -------- ----------------------------------- 4 Number of living units.-A-3- Numlje? of bedrooms ------------Garbage Grinder ------------ Cot Size __.________--------------------------•- . ! ! 1 Water Supply: Public System and name ------------------------------------------------------ - --�--------- --�-------------y------------r�----------- -------Private ❑ Character of soil to a depth of 3 feet! Sand'Q Silt❑ ClayPeat Sand Loom ClayLoomI Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type -----------------------E----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) i NEW INSTALLATION: {No s c tank or seepage pit permitted if public sewer is available within 200 feet,] v PACKAGE TREATMENT SEPTIC TANK'[ ] Size____------------------ - Li Depth Liquid r ,rr ' --- Material---------------------- No. Compartments. - Jf�`� Capacity -- ------------.:-- Type ------------ ---- 1 Distance to nearest: Well `+.'-----------------------------Foundation ---------------------- Prop. Line ---�---------------- .,, Not of Lines ngtii of each line---------------------------- Total Length --------------- LEACHING,,LiNE [ I F ( ^*-.� ' ' _De th Filter Material - - ! ` ,D' Box - -------TYpe Filter M'afierial P f ! Distance to nearest: Foundation ------------------------ Property Line ____-__________.___--- -"'. SEEPAGE PfIT [ ] Depth '"- Uiarnet re \ Number ------------------------- -- Rock Filled Yes (_1 No �] I ----- --------- ,— 4" o f Water Table Depth --4-1 '-------�-- Rock Size V JJ � -Foundation -------------------- Prop. Line,-------------------- `ir Distance to nearest: Weld C______---___ -___--_ E REPAIR/ADDITION(Prev. Sanitation Permit# _---- ------ ---------------------- Date -------�-.-----------.--------1 ! --------------------------- -------------------------- Septic Tank (Specify Requirements) ---- --------"� -------------------------------------------- t� / ,: j'e n --------- -- ` .. Disposal Field {Specify Require�ents � • -�� -• d-� � ,`1 < � / - - c - ppej -- ----Via. ~ : =41sNQ j J (Draw ex i ng and required additi on reve-�e�s del � 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 j and Rules and Regulations of the San 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 become sub, t to Workman'Fp nsation laws of California." 'I .. - - - - Signed�-- � -- ----------------------------------- Owner qm Title ---- ---- --------- - - ---------- ------ ----- ----------- ------------ BY -- -----\1------- - ------------------------------------------ ---- ---- - - - (If other than owner) FOR DEPARTMENT USE=ONLY = - � .. DATE� --�--_-=�--1--��---------------- APPLICATION ACCEPTED BY -------------------------------------------------------------DATE --- BUILDING PERMIT ISSUED -------------------- -- ------------- --------------- ADDITdONAL COMMENTS -------------------------- - - ---- ----------- " ---------------------------- ----------- --------- ----- --------------- ---------------------------------------- --------------- - _ ----- - ---------------------------------------------------- --------------- _----- -_ _ _"--------= -- - - -- ----- - - - ----- - -- - i --- --- �j -gate - = --------- Final Inspection b N ac--� ..----- ----------------------------------- --- + SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M ,y