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FOR OFFICE US .�,,o APPLICATION FOR SANITATION PERMIT ............................... p p Permit No. ,7�.-_.�J. X /0• (Complete in Triplicate) lfK .................................... _ ..................................._....._..... This Permit Expires 1 Year From Date Issued Date Issued ..Y:!3�n7o 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 .. � /JV, _ CENSUS T'A Owner's Name .---- -- .b.f, - t�....-•--•-•--•----...-•-•-- -------------------- -.-. -.-.-Phone ....------•--...--•--........_..... Address v�� . /,. _�_.. C�!- -- ------------------ ------------------City .> LL Contractor's Name .. .. .1_ --=. ?. _/cv!......---•.....................License #��;, ,�p,� Phlrfe�/Af_..,-'-ZX� Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ i ssMotel ❑Other............................................. .' i or Number of living units:---- ... Number of bedrooms ..2.-......Garbage Grinder .. Lot Size Water Supply: Public System and name ..- ----......--•-•---•------•---------•--•.........................:�...----••---•-------------------.--...Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If ye(type _...-;.....�.... (Plot plan, showing size of lot, location of system in relation to wells, buildings, 06 must be placed one reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available w_ it4in 200.feet,) f+ PACKAGE TREATMENT [ ] SEPTIC TANK t ] Size.......................................... _._._... Liquid Depth _---._.-.--__-_____--_____ Capacity -------------_---- Type .................... Material..------.---.--------- No. Compartments ................. --_-- Distance to nearest: Well ______ ---------------------Foundation -.3.f...._-..__.._-.- Prop. Line ...................... .� LEACHING LINE [ ] No. of Lines __................ Length of each line.......-----------._...__.-- Total Length D' Box ............ Type Filter Material ____________________Depth Filter Materia! ..__------;--------_......._................ ' Distance to nearest: Well!---------------___--_- Foundation ......-.. - -.-.._..... Property Line ......__. .............. SEEPAGE PIT [ j 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) ................. .... .. ..... ----- ••--------- ---_------ - ` `� Disposal Field (Specify Requirements) _ / ._� .._._ --- ,�, --k - __ i---- ------ ----------------------•----- i. (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 subject to WorkmaWCompen' Lion laws of California." Signed --------- ------ - ... ------- -• -----------• ------- Owner BY ...._.. Title I -i.................................. (If r than owner) l _ -- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---•-- DATE -----•-E BUILDING PERMIT ISSUED ............ ----- - - .................................................DATE .---- -- - ------- - ------ ADDITIONAL COMMENTS .---___.__- ------------------------------------------------------------------ -------------------- _ ...,.. ................................ ......... ------ ---- = .---- ._-- �I ?d - ......._ -- `r -- - - Final Inspection by: - - -------- .....---•--•• ---............._ .... ................Date ....71..-�..... _. .... SAN OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M i r