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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. 3,S~S ... .............................. _.---- This Permit Expires 1 Year From Date Issued Date Issued y 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 .. l��`°. ._/ ..��_.:C -?. -,.-/ ._ .R. or�:-�EN5US TRACT ..------------------------ Owner's Name S $� -SJ ..�. :...--=••-... •.........................Phone ........._.._.......tel........... Address , ._.......__............... { = ._7............ .......---_. City ------j59"_t.N-0-`-1 n..--•--------------------•--------- y Contractor's Name � ....License #0XEY—'�N3.... Phone -•- 6�1 '�cV Instoilotion will serve: [Residence-Apartment House C] Commercial ❑Trailer Court a Motel ❑Other -------------------____........... Number of living units:...- Number of bedrooms ---/-------Garbage Grinder ------------ Lot Size ................ W Water Supply: Public Syste 'and name -------------•--••----•------ ---------------------------------------------------------------------------------Private Q i Character of soil to a depth olf.3 deet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam fl Clay Loam f Hardpan 6 Adobe ❑ Fill Material ------------ If yes,type ---------------------------- f� (Plot plan, showing size of �of,�location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) ' NEW INSTALLATION: (No ieplic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] i';SEOTIC TANK T ] � Size_________ _ __ _ • Liquid Depth .................... Capacty-------------------- Type _-.- -•---.. MateriI ; - No:��iomPartments ..._.. � ...................... Distance to nearest: Well ................ ..... K:f-,;1'Foundd i ................... Prop. Line ...................... LEACHING LINE [ ) No. of Lines _ .._.....-_........ Length ofeach line...................... . Total rength ............................ 'D' Boni -::-------- Type Filter Materia( ________________Depth Filter -Material ...............................--_._..___:_. F1 r,. + .L r y � : r' ... �L 7 Distance�to`nearest. Well ........................ Foundation --------- - . ,: Property Line ...- SEEPAGE PIT [ ( Depth ---------------- Diameter ___•------_.•--- Number ------------------- ------.. Rock Filled Yes ❑ No Water Table Depth Rock Size Distance to nearest: Well----------------------- --_-----__. ._ Fi3� dation ..-:.:: ...._ -------•- - ------.. Prop. Line ....... .............. REPAIR/ADDITIO (Prev. Sanitation Permit# ..>..._....-•----------------:1.: .__;_.: D2:te ...._...-- .......... ........._.) ...r.y... _ 4�. - ,Y.I I Septic an (Specify Requirem n#s) ....... ,off___ .i" ` _.. ....... . ........ ...... - Disposal Field (Specify Requi e e ts) ....___yp_______ _ __ _ __ '__._:'._. r*0 , -- .............. �... ::::::::::: ------------------------------ k ------------ -- ------------ •----..._.......--.--.........-.-•-------------------------------------------- .............----------- --------------------------------------- ---------------------------------------------- (Draw existing and required addition on reverse side) iI 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 ......... -. -.-.._-•-• - Owner �----- ----.--.-- Owner _ "c...................................................... (If other than owner) FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY /6-;- 2. DATE __..... 7.�---:BUILDING PERMIT ISSUED _...-..-----••----•-- _. ......•-- .....................•................DATE :.................. ............ .. ADDITIONALCOMMENTS -------•.................................................................... .....................................................I..............___...... ...---•................................._.... ._........ - - ----------•......•-----....... ............ ... ------••--:..---•---•-...-----...-------.._.. ... ------- -- - ----------------------------------- � .. . ,_� ----------•--•---••-----•- ---- . FinalInspection by: --------...- ••---- _ ......•-•------------------------- ---------------- ......................................_.Date ....... ... ... 1. V SAN JOAQUIN LOCAL HEALTH DISTRICT t=. y. 13 24 t_�,sR Rp„ sru .y 17? 3 K