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JAG FOR OFFICE USE: ' y APPLICATION FOR SANITATION PERMIT _S -------------------------------------- - -------. Permit No. .Z�i�..- (Complete in Triplicate) '° .......................... ---------------------------- t Date Issued .6.-/7-.�y ................ ................................. This Permit Expires 1 Year From Date Issued l , 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 a'd existing Rules and Regulations: I � JOB ADDRESS/LOCATIONrJ .I��-QQJ/ ,..._ �. -- ----� ------------------------ ..._...- ---CENSUS TRACT __.--_------•-----_--- ' Owner's Name ---- G• �J ------------------------•---------------- r -----------.Phone Addresss- r-lZno........ .../54�r ---------------------- City •�s�l�Eft3�.:.[� - .................... Contractor's Name ........License #ZS4-42-2.. Phone ..'¢-��.p�~•¢ Installation will serve: — _QRes idenceXApartment House.❑ Commercial ❑Trailer Court Motel ❑Other_"--- ---------------•------•----•--•-•-= � Number of living units:.-- ..... Number ofIbed room s;. _;`-__Garbage Grinder _-__.....-__ Lot Size ...� �J�i+� il. + � Water Supply: Public System-and name --•........ ........_•--------......--------------_ --•--•-•-• .....................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑• Clay ❑ Peat❑ Sandy Loam -❑ Clay-Loam:❑ Ht ardpan ❑ AdobeXFill 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.) NEW INSTALLATION: ,jNo.septic,tahk or seepage pit-permitted.-if--public-sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] ( Size-...........�)C., -...._--.-..-.--:-_-. Liquid Depth -------1�..... _..__. Capacity Type Type �jj�7`Material, ,eNo. Compartments -__�. ____...... Distance to nearest:-Well Y-06---.__'________________Foundation .... ---- Prop. Line ..._z1__...._... LEACHING LINE [ ] No. of Lines .....e.............. Length of each Iine..7S_'-7jpS.i. .. Total Length :.��Q.._____.....__ ...' Z '' i .4, !i 'D' Box _ Type Filter Material;/_•�x.-*-'-,_.Depth Filter Material ...._ ..c�......................._......_ Distance to nearest: Well ---/00--_'--_r--- Foundation ---ZD.......�:.._ Property Line j.. . ........... a SEEPAGE PIT [ ] Depth _. !,t--_ Diameter_. .•._ Number _.-.--._. 1.......--__'Rock Filled Yes &--go o 1❑ . Water Table Depths"` '"�..---.._.__�-Y.—-- -_Rock Size ..- -as -_ ..'_- , t / 1 - / Distance to nearest: Well -_----IQ-D..._._!................Foundation --f0... ---. Prop.'Line .__S-__......._. F REPAIR/ADDITION(Prev. Sanitation Permit# ............ ....... -_.._-------_--- Date .................................. f Septic Tank (Specify Requirements) ..�'' -.-__.--- _ --- -------------••---••-----• ----•------- ................-................. i Disposal Field (Specify Requirements) ---- ------------------------------- -------------------------------- ---------------------------------------*................................................................---............................................................ >. (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 b)ect to Workman's Compensation laws of California." . i ` Signed - ---------- Owner BY --•- -- - --------- of - � '- ------ Title .. .a��..S. --------------------------------- (If other than owner) FOR .DEP I;MENT USE ONLY APPLICATION ACCEPTED BY -_-- ..may_,-- ------------------------------------• DATE .----. ".l_7`-7 .----• BUILDING PERMIT ISSUED ...... SSUED --•-- ........ -••--•------•••---...-- ----••-----•--•-----•----•-•••------•-----. DATE -= ADDITIONAL COMMENTS _...... .`. ............ ..• -------------- - - ------------------- ..-.-..----.-........ Final Inspection b ----•-•---••----.....-•---......•---.......••---...••---' `.�.Date ------.�o `_=... ------ ----••--••------•-----•---- .... SAN JOAQUIN LOCAL HEALTH DISTRICT