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.V v FOR OFFICE USE: 1-" - 1 - APPLICATION FOR SANITATION PERMIT :---------- �w (Complete in Triplicate) Permit No. ( _.;7_5.3 -__._________ This Permit Expires 1 Year From Date Issued Date Issued _. _-._ `_(p. 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/LOC ATlOf�1 ._T 1�--- q.- --�t-�3- .---- 1( _,--.-C�U 62�X�a----.CENSUS TRACT __ 7_`__0y0-06 ------- Owner's Name -----U_[.F-----61-L------CO-►%64t3_Y---------------------------------------------------- ------------Phone Address ----------------QC?&--.JA1f�96-ti`[,J S-----_C4-------------------------- Cit Contractor's Name ._ :l1___ NN- 11_ _�s_ � `- Fs�CS --------------------- --- - ------_______.License # � � - Phone Installation will serve: F Residence ❑ Apartment House-0 Commercial:❑Trailer Court :Motel%Other _ 1 1(lC. -___Stgll.�kml__ , Number of living units_____________ Number of bedrooms ____________Garbage Grinder ----------.- Lot Size ----- __ ---____---______.....___ Water Supply: Public System and name -------- ---------------------------------------------------- ------------------------------------------------Private (� d 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. must be placed on reverse side.) # NEW INSTALLATION: (No septic tank or seepage pit permitted if publi)se�,wer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK'X_ Size-----------l- s3 '--- -------- Liquid .Depth -------` --- --_-. �. �_ �, Capacity _-1-2-JC?--.-- Type --- -- t atenal-_&Mg-U,��'_ No. Compartments -----A.............. Distance to nearest: Well ..........,. P '�---------Foundation ----1p�_---_____ Prop. Line ___.::_----:.___,__�J__ LEACHING LINE [ ] No. of Lines __.___.3---- ------ Length of each line--------- - ___-- Total Length ,_.'__�2__-��_� -•-.-- � 'D' Box _- ----- Type Filter Material --------------------Depth Filter Material -------------------------------------------- Distance to nearest: Well ______.-.JPO__ --- Foundation ___IGb__ _______ Property Line __--75------------ SEEPAGE PIT [ j Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ]] No 0 Water Table Depth ------------------------------------------------Rock Size ------------------------- ------ Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Eine ----------------_--- REPAIR/ADDITION(Prev. Sanitation Permit# -------- -'----------------------------- Date ----------------------------------) ti SepticTank (Specify Requirements) ----------------- --------------------------------------------------------------------------------------------- ---------------------------- DisposalField (Specify Requirements) ------------------ -- ---A------------------------------------------- ----- --------------------------------------------------. --- -- ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------- =------------------------- ----------------------- ---------------- ------------------------------------------------------------------------ -------------------------------------------------------------------------------- (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 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 that in the performance of the work for which Otis permit is issued, I shad] not employ any person in such rnanrw as to become subject to Workman's Compensation laws of California." 1 Signed - Owner -- ---------------------------- - - - ------------------------------ ------- Title ---- - - ---------- --------------------------------------- ---------------------- ----- --- ------------------- ----------- other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED �B�Y ---------- ----�1------ -------- ---="=' ---------------------------- ---- ------ BUILDING PERMIT ISSUED ---- ----------10011,----------- DATE ADDITIONALCOMMENTS ---------------------I-------------------------------------=-Ile--------- -------------- ------------------------------------ ---------- ---------- ----------------------------------------------------------- -- ---- ------------------------ -------------------------------------------------------------------------- ----------- ------- - ----------------------------=-------------------- -------------------- --------- - - ------- -----------------------•--------------------------------------------- ---------------------- -------------------------------- ection b Final Ins p Y --- --- `' - -------- ----------------------------------- --------------------------------------Date ------ --------- ------- A- SAN JOAQUIN LOCAL HEALTH DISTRICT v E. H. 9 1 T_ Rev. 5M