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FOR OFFICE USE: } APPLICATION FOR SANITATION PERMIT ----------------==----- Permit No. (Complete in Triplicated --------------- ------------ �� ___ Date Issued --------- _. _ ________________________ This Permit Expires I Year From Date Issued 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 ___ - '71 ----5------- ` �L_- -----------------------------CENSUS TRACT ---S-/Y------- Owner's Name .V i 4 f_N_ :- Phone +5�� % � - p , Address 1Q1 ( �-�- --- city ��' �L=QI Contractor's Name ---- F— --------.License # ------------------------ Phone --------------___---.--------- Installation will serve: Residence ❑Apartment House,❑ Commercial;❑TraileroCo—U —i[ Motel ❑ Other ---------------------------------------^-1� �q Number of living units_____________ Number of bedrooms ---3----Garbage Grinder No --- Lot Size ...r cAf_== _efr—_-7 _.- Water Supply: Public System and name --------------- -------------------------->----------_- — ;. �----------------------------Private El1 Character of soil to a depth of 3 feet: Sand'❑ ❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan Adobe '❑ Fill Material ------- If 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: {No septic tank or se page pit permitted if public sewer is avail ble within 200 feet,) PACKAGE TREATMENT SEPTIC TANK' Size______________________ __ � { 7 � -- --- ------ ------ Liquid Depth ----------------------.... Capacity ---------------- Type -------- ----------- Material---------------------- No. Compartments ---------------------- ' Distance to nearest: Well ------------------------------------Foundation _.- ------------------ Prop. Line ----------------- . LEACHING LINE [ j No. of Lines __________ ___________ Length of each line---_----------_------- ____ Total Length I 'D' Box -----,----- Typ . Filter Material --------------------Depth Filter Material -------------------------------------------- Distance to nearest: ell -- Foundation --------------- _ ______ Property Line ___ __________________ SEEPAGE PIT [ J Depth ____________________ Diameter _______________ Number -------------------- _______ Rock Filled Yes C-] No Water. Table Dept ---------------------------------------------Rock Size ----- - ----------------------- Distance to nearest: ll _________________ ____________________Foundation '_. _ --------------- Prop. Line _________.________-__ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________J SepticTank (Specify Require'ments) ----------------------------------------------------------------------------------•----------:---------:------ -- Disposal Field (Specify Requirements) ----ADD------ 6n: I- _(T— _ --- --"""-------- = -- �. 11 ter` ' ------------ # (Draw existing and required addition on reverse-side) } I hereby certify that I have prepared this application and that the work awilli be;"done in accordance •tenth San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner�or licen- sed ages signature certifies the following: �' s "I certi t in the performai4c�of the work for which this permit is issued, I_shall not employ any-person in such manner as to b c subject t -!fin's Compensation laws of CaliFornia." C ---- -------- Signed - ------- Owner - ------------------ ----------- - d BY -------- ------------------------ f f Title ---------------------- ------ --------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- __V 0 ---- --------. DATE -- ��Q--- ---- .ISSUED-.-eL-- #- DATE_ ------------------.._:— u, ADDITIONAL. COMMENTS f�r-�'t--------------- - _ �_ �TQ^�� -- �" ------- --------- ------ -"- ----- --------------------------- -------------------------------- iE ----------- ---------------------------- Final Inspection by: _ 2z - ---- -----------------------------------------------------------------------------------.Date ----------------------------------- SAN ----------7--=-- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1! '68-Rev.'5M _.