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FOR OFFICE USE: h1/V /Z S`.S --/ -6 l APPLICATION FOR SANITATION PERMIT -------------•---- --------- ------- I� (Completein Triplicate) _-_ -___-- --.. �. - Permit No.•.-:Z7. 9� A0 ----------------- , r - I This Permit Expires 1 Year From Date issued Date Issued`-� Application is h here mad to the San Joaquin Local Health District fora permit to construct and instal! the described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regular c,A:herein JOB ADDRESS L off! �/,-P'0-/ '. i, Z % r r --------CENSUS TRACT Owner's Name -_ K Addressc- " -° - ------------ -------- ----------Phone --��---- - - ---- -------- -- ,� - ----------------------- Cit Contractor's Narne /riL� F = tri------------- / License # �G�c Installation will serve: 1` --Phone ___________________ Residence Apartment House❑ Commercial:❑Trailer Court ❑ 1 Motel ❑ Other -------------- Number of living units:---�M----- Number of bedrooms -_ _ _---Garbage Grinder / fJLot SizeJ _j ---- ¢ Water Su I PAblic System and name - 1, pp Y f� El �' ' .�a-�-------------------------------Character of soil to a depth of 3 feet: Sand [] Silt❑ Clay Private ❑ j y ❑ Peat❑ Sandy Loam ❑ Clay Loam i Hardpan ❑ Adobe' Fill Material -------___-- if Yes, type -------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be laced on reverse NEW INSTALLATION: p se side.} (No, tank or seepage pit permitlted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] I SEPTIC TANK [ ] !Size-- - Capacity--------------------- Type ------- ----------- Material----------------_- o, Com Compartments ` - ----------- Liquid Depth --- ---------�-----•--- IM I Distlnce to nearest: Well A)) � - - - Foundation ---•-----,Prop. Line ------ ----- ......s [ ] No. of Lines g LEACHING LINE Length of ach line------------------------ r ;I. ----- ------ ----- -- - � - - �atal Length e� \ D' Box ------- Type Filter Materib`I --------------------Depth Filter M�ate)al ---__-__- Distalnce to nearest: Well -__--_-__----j>�----. Foundation _.----___- ' 1 --- Proper Line SEEPAGE PIT M p -�_ L l De th - Diameter -- ---- - Number ---- ---F Rock Filed:• es [] Nof] Watelr� Table Depth -------------- -»» I Ik Size----------------- -------------------- Distance to nearest: Well _----______--- __ ______________Foundation il ------- -------- >-------- Prop. Line -.---------•�--------• --Date --------- REPAIR/ADDITION(Prev. Sanitation Permit# " Septic Tank (Specify Requirements) ---------------------- ' ! Disposal Fielld (Specify Requirements) f ----------- --------- ------------------ '_I _ ------------------- ii .. - :� :_---------------------- - -- ----------------------•• ---------- } ]� (Draw existing and required addition on reverse sid� e) I hereby certifydthat I have F1, th�is.�!pplication and that the work will be tione in Ztcmldwith San Joaquin County Ordinances, State laws, and Rules and Re ulations of the San Joaquin Local health Dist`ct. Nome owner or�licen- sed agents signature certifies!lie follow'in j• 'U 9 L— "I certify that in the performance of the w�r'k..for vvhic this permit is issued, i shall not employ cines as to become subject to WorktrrIan's CompensaliAtn laws of,California." Y Person in such manner a. Signed ------ ----- t�l" - ----- -- ------ Owner BY --:--- _ x � _ - _ -' .-c-sTitle i (if oth an owner --*---------------- FOR DEPARTMENT USE ONLYt I APPLICATION ACCEPTED BY --- �_ ------ - 10 . BUILDING PERMIT ISSUED �I - 1------------------------------------DATE -- ----------------------------------------------- - ---------------- --------------DATE ; ADDl710NAL COMMENTS -------!I--__--_ - ----------------- -------- - ------------- ------------------- - ----------- i ------------- ' it --------------------------------------------- ': t - --------- ----------------- ------------------------------- ----- Final Inspection. Y. -- -.-- !I- ___-- f-- -- t Yj -- ----------------------------------------------- ----------- A :DErte - .wrj --�-- ---.- SIV JOA.QUIN LOCAL..HEALT.H DISTRICT.._ ,_ ) E. D'68_Rev..5M. 4._* 1.0 s .. V