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FOR OFFICE USE: + / 6 q APPLICATION FOR SANITATION PERMIT ✓?- ------------- Permit No: Ile ---------------- (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date tissued 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/LOCATION ___.__ A-./�-��'= `-------- ----- - ------------- ----CENSUS TRACT -------------------------- Owner's Name =Q "&_e --,./�_ L��_a ----------- �-- �Phone s y Address ---- v'G - �------- ------- -----------------------------------------------111 City ++1� / '------------------------------- 11--- c #— License #��%2:�.�2 Phone Contractor's Name -��•�-r�- paJ+L��- --------- L will serve: Residence XJ Apartrrient House-[] Commercial :❑Trailer Court i❑ Motel ❑Other ------------------------------ -------------- Number ---------------------------=Number of living units-------f---- Number of bedrooms _.A------Garbcge.,Grinder Lot Size --___ ------- Water Supply: Public System and name ----------------------•------------------------ ---------------------------------------------------------------Private } i Character of soil to a depth of 3 feet: Sand'❑ . Silt❑ • Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam:❑ Hardpan ❑ Adobe Fill Material ___._.______ If yes, type -------_________________ --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, 'etc.' mast be placed on reverse side.) W NEW INSTALLATION: ;No septic:tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK,;[ ] Size--_--------------------=----------•------------ Liquid Depth --------------------,----- N Capacity '------=----------- Type -------------------- Material--------- --- ------- . No. Compartments --------•----•-- = Distance to nearest-.,,Well -----------------------------------.Foundation ---------------------- Prop. Line --------------- ------ 1 3 LEACHING'LINE No. of Liries _______.__ --- Length of each line___________________________ Total Length ---•-•-------= [ l 1':-- - g 'D' Box _._ Type 'Filter Material ______________'_____Depth Filter Material _.__-.----_-_________________-- Distance to nearest: Well z_____________________ Foundation -------------------- --- Property Line ---------.-------`n:_ SEEPAGE PIT [ J Depth ____------------`--- Di miter ---------------- Number ----------------- ---------- Rock Filled Yes '❑ No'01 Water Table Depth --- ------------------------------------------Rock Size ---------------- ----------------- ; � } "___ _... dation Distance to nearest: Well ------------------------------ -' _Foun ---------•---- Prop. Line ---------------•�•---- REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- ------,-- Date _____--_____._� Septic Tank (Specify Requirements) -- 1 --------------- ----------------------------- = = ---- ----- "---------- -------------- Disposal Field (Specify�Requirements) [J _ �6 t Jt ----------- ---------------- ------ _._-f--------I---------- -------------------- ----i-----,-------{---------------------'----------- -r: I JDrow oAst)ng and required addition on reverse + µ Y Y----------------------- prepared �.. application side) ' I hereby certify that I have re ared this a. lication 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:ffome owner or Iicen- I sed agents signature certifies the foll'ow'ing: _ , •'t:.certify that in the performancw;f th #work for which this permit is1ssued, ! shall not employ any person in such manner l t m" 'i f as to become subject to Workman s Contpensatian laws of California. i Signed ---------------- -------------- er - �- IOw ' title (if othe an owner) ` FOR .DEPARTMENT USE, ONLY i !, APPLICATION ACCEPTED BY _.__ __.___ ?' t e 1! ------------- = -----. DATE----------------- '--� -------------- BUILDINGPERMIT ISSUED _"-------i- ----------- ----------------------------------------------------------------- ------DATE----------------- ------------------------- f-------------`-`-'�---;---------a-------------------'T' ---------=--'--.--------------------- • --------------------------------- , 4 ADDITIONAL COMMENTS __�:.-- ----------.------------- ,. ---'-�`----------- -r T------------------------- .-,--------------------------------------- - --- ----- ----------------------------------- ----- ------ ---------- = i: ` ` -------------- ------- -------- -------------------------•---- _�._,_.. ..� �- ; - `'�' -------- ------------------ = - ------_---- - Final Inspection by: ------- ---- Date `. ---------7---------------•------ SAN JOAQUIN LQCACHEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M