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FOR OFFICE USE: ~. APPLICATION FOR SANITATION PERMIT ' ------- -- --- -------------- ---- _�-f-"--��--5 (Complete in Triplicate) Permit No. --------------- This Permit Expires 11.Year From Date Issued 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 and existing Rules and Regulations: JOB ADDRESS/LOCATI --- N _. �----- ------IU RTS L14-N_ -------------------------- CENSUS TRACT __5725V-------- --c Owner's Name --------- -Q-Hr�J �.7------- M-TH-------------------------------------------------------------- -------- ---Phone Address ------.J5_5 5------F. ----- 6-RT0_t_-lt_N_D------------'= City -_MAI-TT ECA------------------------------------------ Contractor's Name -- 1LL�- �plV�` � --------------------License # Phone Installation will serve: r w.Residence t<Apartment Housef] Commercial []Trailer Court ,E] l�r 1 Motel ❑ Other -------------------------------------------- Number --- -- -------------------=------------ Number of living units:__________ Number of bedrooms __rL__--.Garbdge Grinder ------ Lot Size - --------------------------- Water -------------------- Water Supply: Public System and name ----"---------------------------`-,------,-- w;- ------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay,.[ Peat❑ Sandy Loam .X Clay Loam ❑ Hardpan ❑ Adobe '❑ Fill Material If yes,type ---------------------_______ i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NE1lV I•ISTALlAT10N: (No septic tank or seepage pit permitted if public sewer is avai able within 2p0 feet,) f { PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] �, Size---------------------------------------- ----------4iquid Depth ____._._._:_______________ a Capacity -------------------- Type ------ Material-------le . --- No. Compartments _ Distance to nearest: Well __ '_--____________________________Foundation' ____ ______________ Prop, Line _________------------ LEACHING LW—Et ] No. of Lines --------------------- _ Length of each line------------------------ __ Total Length ------------t-_____________ 'D' Box ------------ Type Fifter Matefial ----------`---------Depth Filteraterial ------------------------------------------ Distance to nearest: Well __ ------_-___:__________•Foundation _________________ Property Line ------------------•--•-- SEEPAGE PIT [ ] Depth Diameter ------------------ Number --------------------- ------ Rock Filled Yes ❑' No i❑ Water Table Depth ----------- ----- -------------------------Rock Size -------- ---------------------- Distance to nearest: Well ___ _______ __________________________Foundation _.__ __ ------------- Prop. Line ........ REPAIR/ADDITION(Prev. Sanitation Permit* _ - ----Date _�__-__ Septic Tank (Specify Requirements) ------------------------17��T_____L3�X__,�•�,'�7__CaL-�____�1__n�.� ,vL• l� �' •_•-----t---------------------...--------------------------- ; ;- p T Disposal Field (Specify Requirements) ----- - -•_ , -------------9D-------------------------------------- ------14_b_}?J TI_ nfi4L LEi4C1--} L� N --------------------------------------------------- -- ------":------------ -------_------------------------ -------------------------------------------------------- --------------------------------- -- ---- --- ------- ,1,_(Draw-existing.and required addition on reverse side) I hereby certify that 1 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 erformance of the work for which this permit is issued, I shall not employ any person in such mariner as to beco subject orkman's Compe�tion law f California." Signed --�,�L-1 ;E�-----QW5-------- i----------- Owner By ------ ------ Title --------------------------------- (If er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY L 1 S ------- DATE ----- rL I------------- BUILDING PERMIT ISSUED-==------------ ,---------------- -----------------------------------------------DATE -------------------=-----=------------.---- ADDITIONAL COMMENTS ------------ - - _______________________________________________________ ______________________-__________________._______________._____._____ _ __ ____________________________'______________ ____ _ Final Inspection b ------ ----_.Date ----_ ----� --T--�------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M