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FOR OFFICE USE: .APPUCATI6NFOR SANITATION PERMIT --------------- ---------------------------------------- {Complete in Triplicate} Permit No. .__----__..__.. ------------------ --------------------------------------- ____________________________________________________ This Permit Expires 1 Year From Date Issued 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/LOC TION .____ _ _____ / �!_ - (�ff______--- dV___CENSUS TRACT _____._r___.".'1_._._.__. Owner's Name -- 4 - --------- 4e,-IVV----------------------•----•----------------------------- --------------------Phone.-- ---------------------------------- Address -- � a:VjC__ City �1 --------------------------------------------------------- Contractor's NameY. i� / _pglc,,lfs+ _ / 7.y - utLicense # - ______ Phone �r ' �-• Installation will serve: / Residence 'Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other --------- ---------------------------------- L�.. Number of living units:----1----- Number of bedrooms ____.__Garbage Grinder ------------ Lot Size --------------- Water Supply: Public System and name ----------------------------------------------------------------------_------------------------ ---------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam X Clay Loam .D .---Hardpan-E]Adobe❑—Fill-Material��- y ,-typ (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 PACKAGE TREATMENT dJ SEPTIC TANK[ ] Size---5x----A ------------------------- Liquid Depth ----Nor_-_ C 4 ~. Capacity J9_00___•__ Type'_________ Material.edieos---- No. Compartments Distance to nearest: Well _______�®__�_________________Foundation ---1a--------------Prop. Line ___ -_--____-___.i.- 10 *LEACHING LINE [] No. of Lines _____I________________ Length of each line_____ _______ ------ Total Length- __---Iva............... €, D' Box __,C___.__ Type Filter Materialf-7-4Filter Material ----1C�-------------------- R Distance to nearest: WellUr _____._ _____ Foundation --� r-_ Property Line k$.........:........... r SEEPAGE PIT [ ] F Depth dS __________ ..Diameter _ ��_ Number _.__---`------_--------- Rock Filled -Yes No I❑ ' Water Table Depth ---- �/' ' --- - Rack Size -�f; �} Distance to nearest: Well --- _____Foundation _/d------.---- Prop. Line __ST- -----------t-':f REPAIR/ADDITION(Prev. Sanitation Permit# --------_--------------------_-------------- Date --------------..._.---------------I SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------------------- ---------------------------i Disposal Field (Specify, Requirements) -------------------------------- -------------------------------------------------------------=----------------- --- ----- ------ - ------ ---- ---------------- -- ------- --- --- -- -- ------------- (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: "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 ---- ------- Owner ' BY ^- � - --------------------------------- Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B ----------------------- DATE --`Z- — ---_----------- ----------------------------------------------------------------- BUILDING PERMIT ISSUED ---- ----------- -- --------- -- =-------------------------------- ATE ----- ----------- ADDITIO A CO ENTS ___fJ .c____ o' -C-1 S-141/1; a ------------------ N - .-.- --- ----- - --------- ------------------- ------------------- ----------------- ----------------------- ---------------------------- ---------- ------------ ---------------- --------- _ Final Inspection _ Date '" ' fir f SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 168 Revk5M