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FOR OFFICE USE: -= -4 r -- APPLICATION FOR SANITATION PERMIT ----------------- ----- (Complete in Triplicate) Permit No.- -------------------------------------------------------- This Permit Expires I Year From Date Issued Date Issued -71______ 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: r JOB ADDRESS/LOCATION ._. 212_-- ._ s�_olds-Q1ZRd-s---11 �J®------------------------CENSUS TRACT _G.---•-------• Owner's Name -----T ;th--Ii rs i 7 j, - --------------------•--•--------•----------------- --------------- ---------------------Phone --3&8-17�D............. Address _.32 2 Mast o ci$ren oda-.-A0-avp-*--------------------------. City $C�n1pm Contractor's Name _:0-41_-6,*s t_G.m-Z.ani tp-tJ.Vn __IncLicense # ---1817.8.4----- Phone Installation will serve: Residence ❑Apartment Housef:] Commercial X]Trailer Court ❑ Motel0 Other ---------- --------------------------------- Number of living units:--- Number of bedrooms ----- _....Garbage Grinder ___ Lot Size t Water Supply. Public System and name -----gymter---W-e Private (� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam .❑ Clay Loam -] Hardpan-®_ Adobe-❑ FillMaterial ------------ If yes, type ------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.j R NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feetW ,] PACKAGE TREATMENT [ ] SEPTIC TANK Size---- .UOQ__ ga11a-n--•------------ Liquid Depth --------------- - - - Capacity ._a©©.--------- Type 99"".t- Material----5-9-M M—IeNo. Compartments __2...--------- ---- r 1 Distance to nearest: Well ------Z--- 50 I--___---__--_FFoundation ----2,Q_i_._________ Prop. Line __-__ _ LEACHING LINE p(] No. of Lines ---------------- Length Length of each line----4--------------------- r-_-:_--- -- _-- Total Length -------4Q t --------------- 'D' Box .... -_---_ Type Filter Material -'ffabed___Depth Filter Material _19"---------- Distance __ -_ _ - Distance to nearest: Well _ 00--------------- Foundation ----------------------- Property Line ------------------- SEEPAGE PIT Depth ----- = -�.--__-- Diameter -- -�_-- ------- Number _ --a--------------------- Rock Filled Yes [ No i)] Water Table Depth - -f--------------------------------------Rock Size --- i`------------- Distance to nearest: Well -_--- =----1.OQ t------ Foundation -------------------- Prop. Line --------- ------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------____-• _ Septic Tank (Specify Requirements) -------------------- --------------------------------------- - ------------------------- Disposal Field (Specify Requirements) ---- ------------- _ .. ---------------------------- ---- �- , —(Draw existing and required additiooreverse 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.- Signe . ._ ------- ----- ---- - n ner Owner By - � if ePresident P- ----------- - ,------------------------------------ FOR - ---- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _._ _ - - - -- ---- ----------- ----------- ---------- ---------- ------- DATE -�'�_�y--�---�•------ ---------- BUILDING PERMIT ISSUED ___ _-_.__--___ r ---------- ADDITIONAL COMMENTS -------- --------- - �----- - ------ ----------- --�----------- -- DATE -------------------------------------------- - FinalInspection by ----------------------------------------------------------,- -------'--Y------- ' ._______ -------------------------------- -Date--------------- --------------- --------- -- ---- ------- ----------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M