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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..........,.......................................... ��3-�-e {Complete in Triplicate) Permit Na. ...7................ This Permit Expires i Year From bate issued Date Issued -.-•................................................... Application is hereby made to the San Joaquin Loco] 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: G r ru Ya CENSUS TRACT J08 ADDRESS/LOCATION ... ............. Owner's Name ..._........le i!' .. . . .4:G.! !!!:! �......................... Phone`` �7-s`,7 Add ess t�v r ......................! .. ^i t .... Contractor's Name .._.. . 4__. .:_ +�+ i.sc ..ce s r Licnse'# o? `f :.... Phone ._ .-.c�C?B.T.. Installation will serve: Residence JN Apartment House❑ Commer-di'al T.raller Court 0 Motel ❑Other ...................................`_...�_.� j Number of living units:------ ......Number of bedrooms __5 .....Garbage Grinde .._. --- Lo S;ze ................ Vil Water Supply: Public System and name ....................................................... .�- ? Private ❑ Character of soil to a depth of 3 feet: Sani Silt E •Clay ❑ Peat-g) Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material .A.---•-_-- If yes,type --------_----------------- (Plot ---.---_------------ ----(Plot plan, showing size of lot, location of. system in relation to wells, bu:llddings,t etc. -'st be placed on reverse side.[ NEW INSTALLATION: (No septic tank or seepage pit permitted ifspublic sewee 4s&voilab within 240 feet,) + T-VP PACKAGE TREATMENT [ ] SEPTIC TANK-( ] Size-------- ..................r._......____ .._Liquid Depth _...-----_-----._....... Capacity ----------------•--- Type ._..............�.�Material----------- ""r- o. Compartments ...................... Distance to nearest: Well .................�.---. _i~ Fa�vn_dation ------- -------------- Prop. Line ...................... et LEACHING LINE ( ] No. of Lines -----------------........ Length of each line.-_--...___.____�'. . Total Length It .,e • .,,d ,r l T, D' Box -:-- Type rials*� .:+ :"�l3epth-Filter M terial :.......:... ..: ...-••••••••-• _ _ T e Fi ter Mat , . � __.• ..•.""'""Pro a Line Distance to nearest: Well ...._.__ .:�_...:,Fonda#ion p rty E SEEPAGE PIT O Depth .................... Diameter d _.:...' .:.. �NtYmber _ .........._ :.... Rock Filled Yes ❑ No []. Water Table Depth s R . Rode Size ------------••---• •-•-•-_. t... Distance to nearest.. Well .._ `=__. :Foundation .... .... ...... Prop. Line __.....__ ......... : REPAIR/ADDITION(Prev. Sanitation Permit�# ...._...... -__•- .'.---.-- ---.-- Date _..._.._:................:. Septic Tank (Specify Requirements) ._ ----•---•----•-----:..............:_................. -�. I'( ..... Disposal Field (Specify Requirements) ........ tQn �'Q :�.: ,........_`+ ........... . ------------------------------ - --------- - - ......... . -_.._r_...,. -------- --- .................. ..... -_ ------ ............................ (Drow existing and required addition on roverse,ssjd�: I hereby certify that I have prepared this application antd that thie w rk will be done"hi accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Healti District. Home owner or iicen- sed agents signature certifies the following: "I certify that in the performance of the work for which this p.ermltks issued, 1 shall not employ any person:in such manner as to become subject to Workman's Compensation laws of California." Signed ...................By �""" ....� title .. (if other than owner) FOR DEP IRTMtENT USE ONLY � 1 APPLICATION ACCEPTED BY .......tVJA_-.4?-................. 1 .. ........ DATE . ......... . BUILDING PERMIT ISSUED = # ...DATE ........---•••••......... .............. ' <ST �" - aT. ADT-:_*� !'! ,:::....................................................... ....... ADDITIONAL COMMENTS --------- -------• y " •----. _..__............._._. N..S t _ ,�.......0 l�......i Q1 .....---•--.------ . - -•---•--•- -•-- .......••...... -•--• ••--••• - •------.. .. . ..._ ------- - _ // Final Inspectio , ..... Dae .:s._ !a�. ...... .._ r;.e~ ... SAN JOAQUIN LOCAL HEALTH DISTRICT` `- --- E. H.13 24 1-'68 Rev. 5M 7/72 3 M