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f FOR OFFICE USE: APPLICATIOWFOR SANITATION PERMIT ----------------- ------ �------ Permit No. ---------------- -- (ComRlete in Triplicate - --------I------ -- ------------- =� - -, ------ - i Date Issued --�1�._7L.. • This Permit Expires 1 Year From Date Issued = Ap lication is hereby made to the San Joaquin Local,Health District for a=permit'to construct and install the work herein de cribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: / -.- - SUS TRACT ---------- --------- JOB ADDRESS/LO ----- l.� n --- --- ------Phone Owner's Name -- ---------- 7 Address - ------ ---- +-- City ---. ate-u'-r- ac- 3--------------------- Contractor's Name "-[ ------ ------- ---------------License #0219-2/77 Phone Installation will serve: Residence XApartment House,❑ Commercial :❑Trailer Court ',❑ Motel ❑ Other -------------------------------------------- r 4 -Z- --_ Garba a Grinder --.- Lot Size Z! Jr-- Number of living units:- _/---- Number of bedrooms ____ ------ g �- ----- --- -- --- � i Water Supply: Public System and name ----- - - ,rs�--------hl-----------•---------------•--•--------------------Private ❑ Character of soil-fo a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ 1 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r � { J € PACKAGE TREATMENT [ ] SEPTIC TANK Size--.-- ------ ---- Liquid Depth ------- ---------- Ca pacity/01- --------Capacity/01- 04AZTypeOPI Material-__� No. Compartments -------�.---------- P Distance to nearest: Well le--------------- __��_ ____-_- Prop. Line ---- -Z ' LEACHING LINE �Q No. of Lines ---.±_ .---- Length of each line--------- ' -- ---- Total '-bngth ,_ ��. ----.. 'D' Box .--f--. Type Filter Material ---Depth Filter Material --- ---------------------�____.-__. Distance to nearest: Well __-_ - ---- Foundation ____.-1 --r_-__- Property Line __ ---- ---•--•-- Depth --------- Diameter _--_- --------- Number -----___.--.----.---------- Rock Filled Yes ❑ No tl❑ SEEPAGE P(T [ ] p ---------�- WaterTable Depth ------------------------------------------------Rock Size ---------------------- Distance to nearest: Well ------------------------------ ---------Foundation -------------------- Prop. Line ----------- ......... REPAIR/ADDITION(Prev. Sanitation Permit C# ------- ------------------------------------ Date ---------------------------------- --------------- ) i Septic Tank (Specify Requirements) ------------------- •------- Disposal Field (Specify Requirements) ----------------------------------------- ----- --------------------------------------------- ' = -------------------------------------------------------:----------------------------------------- --------------------------- (Draw existing and required addition on reverse side) I hereby certify that) 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 lice"- sed agents signature certifies the following: .-C. ".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 Workman's Compensation laws of California." -- ------Signed -- - ------------- --------- --------------- O wn er Title F BY (if other than owner) FOR DEPARTMENT USE ONLY (?— —_----- DATE APPLICATION ACCEPTED BY - - ---------- -- ------------------ BUILDINGPERMIT ISSUED ------------------------------- -------------/-- ---- ----------1`----------=---------------DATE --- ------------------------------ ------ �J- ` �--- - -- � ------ ------ -- ---- --- --- ------ --_--- ADDIT L MENTS __-- .-- I ------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------ -------------- ------------- ------------- -------------------- --------------------Da -------- ----------------- �- - -- Final Inspection b ��- -------- --/--- J r IV SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �- '