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L- 7FOROFFICE USE: ;PPLiCATION FOR SANITATION PE�Y Ja 3�f-. _ Permit o. ------- '" = (Complete in Triplicate) ' Date Issued ''- -This Permit Expires 1 Year From bate issue ------------ 4 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 Rus: nd Regulations- r � - -�U_�l�F'Q�Q -- ---i�.U.�-- ----- ------ ---CENSUS TRACT -------------------------- A -- ----- �----• JOB ADDRESS/LOCATION �'� ._ " � y0 -.._.__.---- Phone " t � - - Owner's Name .---(�c .�Q -------------- -----------L C1�1-C ' `i' /------- City Address ------:!�RMIr ------ - '- j` � 5 ___'_ Phone _-_.License # Contractorq Name f Installation will serve: Residence F71Apartment House Commercial ❑Trailer Court F r i Motel ❑Other ---------------- -- -- - . .Size - ` ---- Number of living units_____________ Number of bedrooms -------- Lo Garbage Grinder --.--- -:--- Lott ) � Private ❑ ! , l �- Water Supply: Public System and name -------------------------------- peat❑ Sandy Loam ,❑ Clay Loam ❑ I Character of soil to a depth of 3 feet: Sand'❑ Silt El Clay El - 1 Hardpan ❑ AdobeM Fill Material ---- -- ---- If Yes,type ----------- ---------------- reverse -- ----- laced on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. mustl p („ NEW INSTALLATION: (No septic tank or-seepage pit permitted if public sewer is available within 200 feet,) %SEPTIC TANK:[ ] Size---------------------------- - Liquid Depth --------------------------- L PACKAGE TREATMENT ( ] CapacityType Material------------t--'-;- No. Compartments ------------ ----- �'- ---Foundation ----- - --_----. Prop. Line -------•-----=---•---- Distance to nearest: Well ---------------------------- � '• n, LEACHING LINE [ ] No. of Lines ------ --- Length of each line -------------------- Total-..Length11---::i----•---------------- i _De Depth Filter. Material -------------'- p _ Sox --------'-- Type Filter Material ------------- - --- , Foundation s--------'`- Property Line Distance to nearest'. Well ------------------------ . _ Depth - Diameter ------------ -- Number ----- --------------------- Rock Filled Yes ❑ No SEEPAGE C ----- ------ - ---- Water''Table Depth R Rock Size -.--------- } -----Foundation Prop. Line -- ---------=--•----.-, Distance to nearest: Well ------------------- --------------- --------- Date REPAIR/ADDITION(Prev. Sanitation Permifi# --------- ------------------------- ---------------i ` - a Septic Tank (Specify Requirem�entsl '---- �� '� ` / � ---------- - Disposal Field (Specify Requirements) -- -Q- S ------ -,0-f� --------------------------------------------------- �- ------------ (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 Joaquin f County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,D strict. H16me owner or iicen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I steall not employ any person in such manner j 'as to become subject to Workman's mpe Ian I sof California. --------------- ----- ------- ------ ---------- SigneOwner --------------- Title ----- ---------------------- - Y _ (if other than owner) F06 DEPARTMENT USE ONLY 4 a--------------- APPLICATION ACCEPTED BY -- -- - - - -------------------------- DATE BUILDING PERMIT ISSUED t---------------------- ------ -- ------------- ------- ADDITIONAL COMMENTS --- ----------------------- �- ----- -- ------------ ------ --------------•----- ------------- ------- ----- ------ ------------ ------ --L---- --=--- ------ -------- i---- - ---- - ------ -- - -------- ----- -------------------------- --- ------ -------------------------------- - �_ -- , ------ ------- - ------------------------------------- Da --- ----- �� ---- ------- te Final Inspection by ---- ------- ------ --- ----- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT , E. H. 9 1•'68 Rev. SM