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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT :, (Complete in Triplicate) Permit No. . �-`� -- _ ------------ This Permit Expires 2 Year From bate Issued Date Issued -'�'-/6.70. l 1-"7 0--o 8' 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: x1.5_0'7 q S, Fr 01- sr r , JOB ADDRESS/LOCATION ..-_�V/- ., ,_� v�✓e✓__- l,S v4--, _ _ _�r _ __CENSUS TRACT - - --------- Owner's Name -- J _ �''l f'`'' -�- _✓ '�'-------------------------------------Phone --------------------- K Address - ----- - ...... <---- City - I ✓ _�-- ------------------ Contractor's Name .-- E'.� i---------------- License Phone -----------------____-- Installation will serve: Residence ❑Apartment House❑ Commercial[]Trailer Court Motel El Other .---( c`` �------------------ --- ',❑ Number of living units:-_____- Number of bedrooms _2--- Garbage Grinder __.--------- Lot Size -- 75`' --------------------------- Water Supply: Public System and name ----------4.,--'4-'_r? - ------------------------------------------------------------- _- • ''�= ---------- - - -------------------------------------------Private E]Character of soil to a depth of 3 feet: Sand I r Silt❑ Glciy E] Peat E] Sandy Loam ❑ Clay Loom.[] Hardpan ❑ Adobe ❑ Fill Material ------ If 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 se a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK X [ Size ' 1Q-----•----- -.---- Liquid Depth -------- ; Capacity _13j0 -------- TYPekrE�/.;,, MaterialC�rs�.^� ` -- No. Compartments ------2........ Distance to nearest: Well _Nr1�r -------------------_Foundation -.L0- ------------ Prop. Line _- '_--________..•_' LEACHING LINE [ ) No. of Lines --- ------------- Length of each line------ ____- ------_-_--_-- Total Length 'D' Box --------_--_ Type Filter Material ------1-------------Depth Filter MaterialI Distance to nearest: Well ------------------------ -i Foundation --------------- _---_--- Property Line --- SEEPAGE PIT [ Depth -------- ----------- Diameter--- ----- --Number --"---------,------ -------- Rock Filled Yes ❑ No . r Water Table;Depth ---------------------------------Rock Size Distance ta.nearest: Well --------------------- ----__--•Foundation -------------- z---- Prop. Line --------------- REPAIR/ADDITION{Prev. Sanitation`Permit 4_f.--_----_-__.-. -----_ Date -------------- ! _-) -------------------- ------------- __-- 1 .� Septic Tank (Specify Requirements) -----°-- ------- --------------------------------------------- - ----:------------- --•------------------------------ Disposal Field {Specify Requirements) ------------------------------- - - ... ------------ - ----- -------------------------- ------------------ -------------------------- -----------=----------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared thii application and that the work will be done in.accordance with San Joaquin County Ordinances, State Laws, and Rales and Regulations of the San Joaquin Local Health :District. Home owner or licen- sed agents signature rtifies the following: �. "I certify that in t rformance of the work for which this permit is issued, I shall not employ any person in such manner as to become I _to Work s Compensation laws of California." Signed --- _ --- -- I ------------- ------ Owner t By ---- -----`-------------------------------------- -------------------- ------ ----------------- Title ...... (If other than owner) y h. - ---------------- ------------------- ------------ 'FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----____-- _ --------------- DATE ----- - -11J`7�-----------.-.- BUILDING PERMIT ISSUED -------- ---------=-- ----- - ----. -,-----------DATE ------------------- ADDITIONAL COMMENTS -------------------- -------- ----------------------------- - ------------- --- ----- - ---------------------------------------------------------------"--------7.--------2--C--�---_--_-_----_-_-_----_---- - -------------------------- ---------- = � ---------_--Date ----ina Inspection by: ------ --- ----- SAN ------------------------------------ JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M.