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t w FOP-OFFICE USE: e APPLICATION FOR SANITATION PERMIT u ...... .................. 7 (Complete in Triplicate) Permit No. ....-- This Permit Expires I Year From Date Issued Date Issued .._�?.'.�:-�.� F Application hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein f described, This application is made in compliance with County-0rdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIONL�I4/—e..................... ------------- --_.............CENSUS TRACT .......................... Owner's Name ...... l < ._. �ifdr� _ .................Phone ......... Address ....... �/_.._:............... ... City�3�'_ ............................... ��r✓ �>Contractor's Name _--.License # ��'� -. Phone Installation will serves Residences Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ...... ..................................... . . g ....... g ,� -.... Lot Size .�J ..�.'C _.L .............. Number of living units:.... �, .,_ Number of bedrooms Garbage Grinder ... - y Water Supply: Public System-and name ��-pp.` E ._.. 1, .�'t.✓�✓les�r.............. _ = Private ❑ Character.of soil to a depth o 3 feet: Sand'❑ Silt❑ Clay ❑, Peat E] Sandy Loam E] Clay Loam E) Hardpan-E] Adobe Jg Fill Moterial ...... If yes,type '.------. ..--••---••-• t (Plot pl`an,`=sh-owing "size of,lot, location of .'system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (Noy septic tank or s epage pit permitted if public sewer is available within 200 feet,l I' P PACKAGE TREATMENT [ )',: SEPTIC TANK t:) Size,.......................... Liquid Depth .................. .! Capacity .- , .---: �` -- Type ..................._ Material----------............ No. Compartments .-- `4 "._ S Distance to`nearest: Well ----------------------------Foundation ................ Prop. Line ----- ................ LEACHING LINE [ ) No. of Lines) Length of each line ............. ... Total Length ........-:.........._ N i D' Box ...... ... . Type Pilfer Material --------------------Depth Filter Material ......_.___...__.--.----.f__--.-.-------.--- ' Distance to nearest. Well ....-------------.------- Foundation ........................ Property Line -_------._ --._ "` Rock Filled Yes No .-.._-__. Diameter ..:............. Number . ........ r, r SEEPAGE PIT [ � Depth [] � Water Table Depth Rack Size _... -------------• ` C 9 ' Distance to nearest: Well,':::.:::.................................Foundation ----------..-------- Prop. Line ................ REPAIR/ADDITION(Prev.. Sanitation Permit#-...............'•-- ••-.-_---.---.....--.. Date ,_. -------- .--------°----.-� 1 Septic Tank (Specify Requirements) ----- ------ ...... Disposal Field (Specify Requirements) d-�,v, .. -•-•., ........ ........ `. ... ..... .. ... .._. (Drdw 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 Regulafiotts 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 -- --?—.77..�. ��'.._ Owner By ... Title . . ........( � %. - .. -------------- ._... - --- ..(if n owner[ r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... ...._. . ....... ....... DATE ._ -r. .. .. BUILDING PERMIT ISSUED _- . ...--.... SATE ..........................------- ........:. ADDITIONAL COMMENTS f/ 17-� �: ---------- ------------- ..... -------------------------------------- -------•-- --- .. ......................... . . . ...... . ..... Final Inspection by: .. - ..... Date .... _.�,.Z ~--- -------- _ ` SAN JOAQUIN LOCAL HEALTH DISTRICT E_ H_ 13 24 i.-AR ep„ SAA ''". 7172 3 M i