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l FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT �� _� Permit No. - - -- -- ------ E �f � /-7�-- - -------- -- -�----- - (Complete in Triplicate} _/l-' date Issued _f"2 10 This Permit Expires 1 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/LO CATI N _ --c2_�-" "","-- c° +��P � i e/-------CENSUS TRACT ------------------------- Owner's Name _._ `-------------------------- - - -----------Phone ------------ ----------------------- - �f' City - ------------------------------------- Address = = --- - ------ - Contractor's Name -.- � � = ,� �t------------------------ ----License t 60101 � Phone'J� � f� Installation will serve: Residencepartment House ❑ Commercial ❑Trailer Court i❑ Motel ❑Other ---- --------------------------------------- Number of living units:______ Number of bedrooms %3------Garbage Grinder tV'�r ;? Lot Size Water Supply: Public System and name ----------------- -------------------------------------------------------------------------------PrivateX Character of soil to a depth of 3 feet: - Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes, type ---------------- ----------- JPIot 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,) p SEPTIC TANK Size_._ ` -- Liquid Depth b. PACKAGE TREATMENT �-[ ] - -- ------ ---- -- - -- - - - - --- Capacity f;,_,®V Type Material4d pf7_e-x"" No. Compartments -----_ __ ____----- t , / i. Distance to nearest: Well ---------6-.;! ------------------Foundation %J----------- Prop. Line ---4_> -.------ LEACHING LINE X No. of Lines -------�----------- Length of each line---6 -- --- ------ Total Length __ .t _._______-- /�J�P p 0r D' Box Type filter Material ✓: ____ _�lL�De th Filter Material /�-______-_.____ ' Distance to nearest: Well 31 ----------�� Foundation ---'CrA - ------ Property Line SEEPAGE PIT Depth _i _1--- Diameter ----- Number __-��. .__-______________ Rock Filled Yes No i❑ it Al Water Table Depth ---- f ----------Rock Size _---- Distance to nearest: Well ___�_ -`--------------Foundation -- --"_-""" Prop. Line .. --.---•- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------- -----) Septic Tank (Specify Requirements) -------------------- ---------------------------------:---------------------------------------------- Disposal Field {Specify Requirements) -------------------------------•-------------------------------- --- �: ------------------------------------- --------------- -------------------------------------------------------------------------------------------------------------------------- -------- (Draw existing and required addition on reverse side) r 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 orlicen- sed agents signature certifies the following: "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 Comp tion laws of California." Signed . ------- ------ -------------------------- ---- -- - ----------------------------- Owner ` �- - Title --- --- - - - ---- - --------------- --- ther than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _��--- � --' -------------- ----------------------- ---------. DATE --9:77--- ,- -----------&-- BUILDING PERMIT ISSUED ----- -----------'- DATE ----- ---------------- - ADDITIONALCOMMENTS ----------------------------- ----------------------------- / �-------------------------------------------------- -------------------- ------ --- --------------------------------______::__ _=_:_: _j- __ _::_ _, f_===_q_,_ -----.___ _____:::_______----__________._:____ _____:_::__ -_:_:_____:_::__-__ -------------------- --------- -- --- -- ---------- Final Inspection b �J r P Y� ------r Yi11� ----------------------- ----------Date --- ---� ��-- -- - -� (/ 5 JOAQ N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M