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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -----------/fes o Permit No. T 3 /`-'--- -- (Complete in Triplicate) ------------------------------------------------------ 3 a -7-3 _ This Permit Expires 1+Year From Date Issued Date Issued 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/LOCATION .-_-� r��--- ----- ----- ----- --- CENSUS TRACT ----------------------- Phone c,�L� _-'_d7� Owner's Name - LC -Q� < ' Address ------ -------- Z_(Q- ------ -------- lrL '--�` ``"_- -� . City ---- ----- - ------- --- ----------- -------- - Contractor's Nome ----------- ----- --- ---- -- --- ------ ------ - -- ------- :--- .License # _1 ��-- Phone ) ` Installation will serve: Residence XApartment House E] Commercial ❑Trailer Court i❑ 3 II Motel ❑Other ----------------=-------------------------- Number of living units:----l-_____ Number of bedrooms ___-___Garbo Pe Grinder ------------ Lot Size -------------------------------------------- Water Supply: Public System and name --------------------------- --------------- LCa'/__ -- -------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'E] "'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.) R NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK! ize------ /T�--�--___---•----_______ Liquid Depth ___t�__�'_______.___.. ��i�___ . . Capacity TYPe _________________ MaterialC _ No. om Partments __ _ f r Distance to nearest: Well ------------------------------------Foundation ____l0----------- Prop. Line ___..�_- ....... r_a l LEACHING LINE f, No. of Lines _-_______ _ _` -_--Length,of each I�i � Q__ 11 � _1� Total Length , e --....._._.___ IIr 'D' Box ------- ---- Type Filter Material_ _ _______Depth Filter Material _.______,�_-________________-__.___--- V r Distance to nearest: Well ________-_____:____ Foundation -----/0______.___ Property Line __-5------------------ N r SEEPAGE PIT �(] Depth __�'-S______ ___ Diameter s'__. Number -------2- -------------- Rock Filled Yes No Water Table Depth ------------------------------------------------Rock Size IX-------------------- ,G Distance to nearest: Well _________________________.------------.Foundation ---/_0._b._____ Prop. Line _--_--_____..._... REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----_-----------------------------) SepticTank (Specify Requirements) ------------------- --------------------------------------------------- ----------------------------.------------------------•---- -. , '� DisposalField (Specify Requirements) ----------•------- -------------- --=--- ------------------------------------------------------------------------------------------ � --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------11------------------------ -------------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 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 --- ------------------- ----- --------Title �Owner�� - - M G - BY - ------- -- ----- NN (If oth an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . J BUILDING PERMIT ISSUED -------------------------------------------- ------------ DATE ADDITIONAL COMMENTS . --�-7`s- --O� ------------------------------------------------- -------------------------- - ------------------=--------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- ------------------- ------------------ - -- --- -- - ------- -------------------------------------------------------- ------------------------------------------------------------ ------ Final Inspection by: - -------------------------------- --------------Date _.t _ 3. AN JOAQUIN LOCAL HEALTH DISTRICT F- N, 9 1_'AS Rev_ 5M