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k .:A _ FOR.OFFICE USE: fi, APPLICATION FOR SANITATION PERMIT ` _.- .� (Complete in Triplicate) Permit No.._.H._-� _ ' -- --- ------------------------------------ Date Issued __7�`8-�9 This.Permit Expires ] Year From Date Issued r i' ___________________-_-.-__-.-.._.____.____._ E` 3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein 1 described. This application is made incompliance with County Ordinance No. 549 and existing Rules and Regulations: rt JOB ADDRESS/LOCATION . _.�_�- ;'` -_'_ �'©/�'�_ QAC---F--MAA17i;CA----CENSUS TRACT --- ----- --------------- I Owner's Name A_ 11��f?._ ,i /I------------------------------------------------------- - Phone( Address - i y`" Cit -_i C • - Contractor's Name �XD/gS '�Jli __ _______--_":License - -3� Phone R Installation will serve: Residence [g partment House❑ Commercial ❑Trailer Court i❑ ' Motel ❑Other --- ------- --------------------- Number of living units:.... Number of bedrooms ______Garbage Grinder _._ Lot Size _ '` _________________ Water Supply: Public System and name.-------------- ----------------------------------------------- ------------------------------------------Private [I�� Character of soil to a depth of 3 feet: Sand'[�ilt❑ . Clay ❑ Peat E]: Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ' - -- If yes, type _ (Plot plan, showing size of sot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) F NEW INSTALLATION: (No septic tanle or seepage pii permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] .('SEPTIC TANK [LJ,-' Size- �(��_1_K4 I , , r_________________ Liquid Depth ----------------- Capacity/ --________-_____ Capacity �_D_U4 YP� 7�--__ Material � No. Compartments ---I------ Distance .to nearest:.'Well --5_ _________________________Foundation _L__0___-________ Prop. Line ----------.------- .___ (,V LEACHING LINE [-r"' No. of Lines_ ______ _ `_.a Length of each line._'�1.-�.------ _- Total Length f -r__"______- f a z l #,r D' Box .. ___- Type Filter MaterilPo al. C/ _____ Depth Filter Material /-- // Distance to nearest: We I1�Q-'------------ Foundation C?-_.---_---- Property Line ------------------------ SEEPAGE PIT J ] Depth } - Diameter ___. _______ Number ________________________ Rock Filled Yes No Water Table Depth ------------------------- \ Water Size ------- ---- -------------- Distance to nearest: Well _ ________---__ .''-______Foundation -------- -- Prop. Line �________________ REPAIR/ADDITION(Prev. Sanitation Permit# ----_--___________________________�____ Date ___ _____________________________) Septic Tank (Specify'Requirements)---------- --------'---------------------------------------------- 11------------ Disposal Field (Specify Requirements) -----------7--------------- =------------- ------- ----------------------------------------------- a---------------------- . ey--------------------------------------------------------I----------------------- (Draw existing and required .addition on reverse°side) 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,. and Rules and Regulations of the San_ Joaq.*uin_Lccal Health District. Home owner or licen- sed agents'sigrecfure certifies the following: I "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 subject to Workman's Compensation laws of California." t Signed # t g ----------------- ----- ------ Owner i BY --- ------------------------------------------------------ (if ---- ---------------------------- ---------------i Title �Q-�(= �1� (if other than a er)' " FOR DEPARTMENT USE ONLY f APPLECATlON ACCEPTED BY .. tF;• ------------------------------------------- - --------------- -• DATE --------- BUILDING PERMIT ISSUED_; .s- - --- --------------------------'- --------------------------DATE ----- -------' .. F ADDITIONAL COMMENTS $ "'°^ --------------------------------------------------------------- ------------------------------ t -------------------------------------- -------------------- ----- -- -- - ------------------- ------------------------------- ------- - - ------------------------------------------------------ - - ' Final Inspectio : __ - --------------------Date Date __-___ __ • �.,.. r __ r. SANJOAQUIN.,LOCAL.HEALTH-DISTRICT E. H. 9 1-'68 Rev. 5M