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a FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ <------------------------------ ------- Permit No". -7�- �dS7 (Complete in Tiplicatel �:, --------_--,-__._-_/..'tom______________________________ 'S K."'R :. !j _w -- This Permit Expires 1 Year From Date Issued Date Issued �0-�)- _ _ lY ------------- ------------------------------- -- Application is hereby made to the San Joaquin Local Health District for a per 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 ------- --' `-- --D ---------��`---- - -------- -------------- ----CENSUS TRACT Owner's Name -------- _0h-A RA *t----------- --L t ------r�-- ---------- --------Phone ------------------------------------ ----------------- City ------------"---------------------- - City % 1-t'-----�`-�------- Address ----- -Contractor's Name ---__ --------License # Z.6-7/5 Phone Installation will serve: Residence partment House Commercial ❑Trailer Court ;❑ Motel ❑ Other --------------------------------------------- Number of living units:--/---- Number of�bedrooms __---___Garbo a Grinder -_ Lot Size --- Water Supply: Public System and name ____-- -- ✓ sC-----.-- cel_��----------------------------------- ------Private E] Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay [-],4-,.Peat ❑ Sandy Loam ❑ Clay Loam,E] Hardpan ❑ Adobe 0( 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 public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f Size__ � �-- _-__f -=-c�'�-- �.+ Liquid Depth ---- ----------,-••-- Capacity/a r Type f Materlal__3-"":& No. Compartments _ :.......... .... °_------Foundation _- _.� r Distance;to' nearest: Well --_ -- __---._.._ Prop. Lute ---_ -----.-._-- LEACHING LINE 1,N" y No:sof .Lines D' Box .____ _._._____-___ Type Filter Material -f'`l.�- �-- Length of each line____ -- -- Total Length ,; ----------- w , 4 ---.Depth Filter Material ---: ---------------------------•------ ____� Distance to nearest: Well Foundation ----- ____ Property Line ___ ........... SEEPAGE PIT Depth -: Number _ -_ -_�_________ ____ Rock Filled Yes No C3 j�^ �---=- Diameter ----7---- ----- - f- t 31b, Water Table Depth ------ ------------------- -------Rock Size -----;;- - ------ . Distance to nearest: Well ------- t_......._ - -- ----Foundation "_._1:_ _f------ Prop. Line ____ _______________ REPAIR/ADDITION(Prev. Sanitation Permit# _________________ 1 ------------------- Date ----------------------------------� , Septic Tank (Specify Requirements) ---------------------- -----------------------------•---------------------------- ----------------------------,.---------------------------- DisposalField (Specify Requirements) ----------------------------•---------------------------------------------------------------------------------------------•---------- ---------------- ----------------------------------------------------- ------------- ---------------- ---------- ------------------------ ------------------------------------------- -------------------- -- ------------------------------------------------------------------------------------ ----------------------------------- (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 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 this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------------- a ----------- Owner _ _. ----- --------------- i K By ------------------------------ ' C-Alc '�--_--V �`�� :.----- Title ----------- ��--------1'��L`.......---------- (If other than owns FORD ARTMENT U ONLY APPLICATION ACCEPTED B ---------------- DATE ' BUILDING PERMIT ISSUED ----------------- -------------------------------------------------------------=--------------DATE -------------------------------------- ADDITIONALCOMMENTS -------------- -------------------------------------------------------------------------------------------------------------------=----------•---------------- --------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ------------------------------------------ ---------------------- ---- - Final Inspection by: S)--�-- Date ._�_�. -- � '------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M W,\,)