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ti.. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------------------------ Permit No. ---Z (Complete in Triplicate) ------------------- -------------------------- This Perm'rt• -Expires ] Year From Date Issued Date Issued _2-��IZ_ 1� ----------------------------___-_----_ _ -_ _-__________-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein v described. This application is made in compliance with County Ordinance No. 5A9 and existing Rules and Regulations: JOB ADDRESSAOCATION --- WOO --__-____CENSUS TRACT ---1 Owner's Name ------------------P-E7-�c-t l r l -J Q i - Phone Address l � /----1151------------------------------ City _ - rx} x Contractor's Name --------------------•-------- - ------------------------ -------=-------.License #°�C�.S'. �-7__ Phone - - -- - -.�.a. .: Installation will serve: Residence ❑ Apartment House°❑ Commercial ❑Trailer Court ',❑ Motel ❑ Others-------------------------------------------�[ Number of living units:-__- ------ Number ofsbedrooms _Garbage Grinder Fs Lot Size __291__ J --------- Water Supply: Public System and name ---------- - - - --------Privatel�.,� Character of soil to a depth of 3 feet: Sind'❑ Silt❑� Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hprdpan E] Adobe ❑ Fill Material _ff a If yes,type -___-__--_--_-_----_----- r (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 seepaqe pit permitt/___ ublic sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK' Siz .. f - -------_- -- Liquid Depth --- c --- ----- ----- UVB Capacity fid---- TypePREFA- terialMAICK___ No. Compartments ------ ------ 11 istance to nearest: Well ------- -- _-----------Foundation --"t� --- Prop. Line ----Is y LEACHING LINE �No, of Lines ;1-----2-------- Length of each tine---- --------------------- Total Length ---- ---------._f_.- 1 'D' Box y4 :Type Filter.Material RACK---Depth Filter Material --IV---------------------------------------•- I `f s/ Distance to nearest: Well -_--- - __ Foundation ---AQ- �----- Property LineS- ----4 ------_ y- SEEPAGE PIT Depth Diameter ' Number "' Rock Filled Yes ❑ " Na ❑ tC 1 p ------------- --- f Water Table Depth -----------=-=-vA----------------------.....f Rock Size ---------------------- /------Foundation -------------------- Prop. Line ----------------- f Distance to nearest: Well ---_�--K--------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------- ---- -------- Date ------------.,#-------------------- ) Septic Tank (Specify Requirements) --------_------------------ - ------------------------------------ --•----------------------•---- .-----------------------•---- Disposal Field (Specify Requirements) ----_-_--_. - - ---------------------------------------------------------------------------------------------- - r -- -- -----------------------' ------------------------------------------------------------ •__-`-n----------------•-------------------------------------------------------------------------- (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 ccordance 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: If ___4 "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 beco a it to Wo kman's Com ensation laws of California." SignedA -- -- ----- ------------------------- By ----------- ------ Owner By ------------------------------------- ------------------- ---------------------------------------- Title ---- ----_------------------------ --------------------------- (If other than owner) T FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... ce -------------------------------------------------------- ------------------ DATE ------ .7_7.71--c BUILDING PERMIT-ISSUED ---------=-- - -- ------------------------------------------------------ - - --------- - ------.—DATE--- a:.}� - ADDITIONAL COMMENTS _ -'- -'---`-'�------ ------------------ ------------------------------------- ----------------- --------------------------------- - - - -----------•-------------------------------------------- -------- -. ._ - ------------------- - --- ----- -------- -------------------------------------------------------------------------- ---------------- -- -------- - - -- ------------ ------------------------------------------ Final Inspec Date -------- - -- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M