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FOR OFFICE USE: i APPLICATION FOR SAMITATION PERMIT / �Z --------------------------=----------------------------- +� '"" Permit No: ____ __ `_ (Complete in Triplicate) - --- ------------------------------------------------- i . Date Issued .___�`� _.T� -------------------------------,--------_----------_----- This Permit Expires 1 Year From Date Issued e { 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 e ' i g les and Regulations: JOB ADDRESS/LOC TION .--f- �--- -------- - ------C.--L____ - --- -- - -- --------------c`'L SIDS TRACT --------------.----------- .f " Owner's Name - V,-4------ = � ----- - .Pone --�; - �j Address -` -- ----- -----------------1 �-------- = City Contractor's Name ---___ ., _ - .�- License # Phone -��-----� Installation will serve: ResidenceApartment House°F] Commercial ❑Trailer Court ',❑ Motel ❑Other -------------------------------------------- Number of living units:... Number of bedr s _____Garbage Grinder ._._ Lot Size vdX.- � --- .---_ i Water Supply: Public System and name ---------- -- -_- -------------- - Private ❑ I Character of soil to a depth of 3 feet: Sand.'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam 1 Hardpan ❑ Adobe Fill 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: (No septic tank or seepage pit permitted public sewer is available within 200 feet,) O iPACKAGE TREATMENT { ] SEPTIC TANK'[ I IZ7��/ ize_______�_______________ -- Liquid Depth --------------------------Capacity --------------------- Type -------------------- Material------------- -------- No. Compartments .-- •--------.-s--- Distance to nearest: .Well ___________________________________Foundation -------- ------------- Prop. Line _____-.-__,___r__-- LEACHING LINE No. of Lines ____ - - ------------ Length of each line---------4"4�;?--------- Total Length)......05-7- 'D' Box ___ Type Filter Material ____Depth Filter Material __/--.9-_______________________________ ,• r Distance to-nearest: Well � ----________ Foundation ___ C __ ----- Property Line SEEPAGE PIT Y Depth -- Diameter _ __r Number ---------Z..__------_ Rock Filled Yes , ` No ,0 Water Table Depth-, , Rock Size -- -�------- Distance to nearest: Well ---- i�_____________________Foundation ____ _______ Prop. Line ..._4 __.__. ....- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------} Septic Tank (Specify Requirements)----------------------------- --------- �� -33/14-- ----------------- --------°----------------------------------------------------'-------'"------ •------._--------------------------------------'-------------__-_`---'------------'------ --------------------------------------------------------------------------- ---- _------------------------- --.-- ► (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: t. / "I certify that in the performance of the work for which this permit is issued, 1 shall not employ,-any person in such manner as to become subject to Workman's Compensation laws of California." Signed -- -- --- ---- ---- --------------------------------------- ----------- Owner .. BY �� - �P ss.�JL�� Title ` ' %% f (f other than owner) j = FOR DEP MINT US NLY42 { 'APPLICATION ACCEPTED B -------- `] ---- ------------------------------- DATE ...7 ---AT.- --- y --------- $UILDING PERMIT ISSUED --------------------------------------/_ - ------------------------- ------------------------------------DATE -------------- ------------------------ --- ADDITIONALCOMMENTS --------------------------------- ---------------------------------------------------------------------------------------------------------------------------- .. F f Y .___________________.__________________.____.__________-___._______--_-_ _----------_________.________________________._--.-----______________________-_____-________________----- 4 ___ _______________________ ______________________________________________----------____-----___--------- ____________ __ __ __ ___ _ ___ _____________ Final Inspection by ----------------------------------------------------------------- Date' SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M