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Pr O VICE USE: P ° APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: ---7_ -- ----------------- -------------------------- This Permit Expires 1 Year From Date Issued Date Issued __3_�� _�- Application is hereby made to the San Joaquin Local Health Districtrfor 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: 2�F82 Car-oenter-•Ad,— JOB 'ADDRESS/LOCATION --------- ------------------- --- -- ,-- 1 CENSUS TRACT -- ------------------Name .---------TOMMY Williams___-- ----------------------------------------------------- -------Phone . -62—.2, 2.3-9--------- Address -------------------- --------- ------------------------------------ ------------ City -/S tkn-;--------------------- Contractor's Name $� �� d-' Septi-C---TR k-----------------=-------License4 ---268951----- Phone ---46-3'-7 4 ----- Installation will serve � Residence ❑Apartment House❑ Commercial Trailer Court ',❑ j I Motel ❑ Other [ Number of living units..-;�y7__1 Number of bedrooms -----5-----Garbage Grinder --- Lot Size ---------------1__.�C ____________. Water Supply: Public System and nameA----------------- '"=--------------- `-------- - F= ---------Private ------------------ Character of soil to a depth of 3 feet: Sande Silt❑ " Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 f Hardpan ❑ ` Adobe %] Fill Material _____________ If yes, type ---.--------------_- (Plot plan, showing size of Iot, location of system in relation to wells, buildings, etc.' must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepageI-pit-permitted'1f-public sewer is available within 200 feet,) PACKAGE TREATMENT .[ ,] SEPTIC TANK.{ 1, Size-_!-_�___ _ Liquid Depth .____________-7---------- Capacity --------------------- Type -------------- - r __ No.. Compartments ------•------ Distance to nearest: Well -------------- Foundation ---------------------- Prop. Line ---------------------- LEACHING ------__------- ,l LEACHING LINE [x] No. of Lines 1------------------- Length of each line--- 9Q_'--------------'Total Length -----90_',___________..._. f' D' Box __.__.____-- Type Filter Material __2'!---------Depth Filter Material -----------IQ'! Distance-to_nearest-WeII.__.___-________ _______ BQ f- Foundation. _ '--------- Property Line ---8�_;_-. --•........ SEEPAGE PIT ° [ ] i Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes- ❑• No iC /a t ; Rock Size Water Table Depth ----------------------- { Foundation ? r Distance to nearest: Well ------------ -- ----- ---- Prop. Line ------- ----- REPAIR/ADDITION(Prev. Sanitation Permit # ------------------'°. t------------------ --- Date --------AU.F•---- 2 Septic Tank fSpecify Requirements) - ---- ---------------/- ---------------------------------------------- 0 Leaeh_Lne. Disposal Field (specify Requirements) __._9____-_- - -- ------------------------------------------------------------- s ---------------------------------- ----------------------------=---------- ---------------------- ------------ ,+ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this appiicatio'ri and`thaf tl e" fork will be done in accordance with Sari 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 "1 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." 'Signe d 5 Owner � ---------- By `. `'� Gi c! ----- Title --------Cantractor t (If other than-owner) ; ------------------------------------------------ { 'r FOR DEPARTMENT SE ONLY APPLICATION ACCEPTED BY"_--_______-__.___- ---_-- DATE all BUILRING.,PERMIT.ISSUED -------------- -- ......... ........-` :DATE - ._ --- -- _ ...... . ADDITIONAL COMMENTS --- -- -------------- ----------------- - - - - -- -------- - -- ---------------------- - � ---------------------------------------------------------------------- ---------------------------------------------------- ---------------------------- ---------------------------------------------- ----------------------------------------------------------------------------------------------------- --------- -------------------------------- ---------------------------- ------------------------------------------------------ -------- Final Inspection by: --- - -------------------------------------------------------------- Date SAN JOAQUIN L6CAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M d.►