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FOR OFFICE USE, : APPLICATION FOR SANITATION PERMIT Permit No: �04�.fA..:'.� ............. ......................................... . .. lComplete In Triplicate) _...• This permit Expires 1 Year From Date issued Date Issued Application is hereby mad4tthe San Joaquin Local Health District for a permit to construct and install the work herein described. This applicationde in compliancewith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION �.-/ / �l` !7.//..�Y......-.. .ll .................:...............CENSUS TRACT 9. .......... Owner's Name ... f"..Ili.-$.'. .-... ..........................� . ............Phone .�2 .. '?� ....... Address ....,� .......... ................... ................... . City - ^................:.......... ... . .. .... .. Contractor's Name -.-../��y•� ©. 1� License # 7a�.1..:.. Phone .� : '•� .. p ❑ Installation will serves Residence 0 Apartment House Commercial ❑Trailer Court 0 Motel ❑Other .....:....................................:. Number of living units,......... Number of bedrooms ..... Garbage Grinder Lot Size .. c .4 •% 48••••••-•••••• . r Water Supply: Public System and name ......................................................... .....................................Private [3Slit Character of soil to a depth of 3 feet: Sand ❑ Clay ❑ Peat 0 Sandy Loam 0 Clay Loam ❑ „. - - Hardpan 'Adobe ❑ FIII Material ............ ye:,type ............................ (Plot pian, 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,) / 1 Size.. .. L........•.---- Liquid Depth ...�1 ............. PACKAGE TREATMENT [ ] SEPTIC TAN ...../ �. 1 , Capacity ..169:0......... Type � wet. PSL emoterial...................... No. Compartments ... � i 6 y Distance to nearest: Well .....................Foundation .--rib............. Prop. Line .., ............... No. of lines .... ...... Length of each line......�C7................ Total Length ....� .0............. J LEACHING LINE ...-- ..... t i 'D' Box ,..... Type Filter Material 09&.......Depth Filter Material ......a..//............: .••••- ... otion Property Line ' Distance to nearest: Well s M ...............C Num I '-SEEPAGEj Depth ... ...... Diameter -.•�........ .. Rock Filled Yes o Water Table Depth ................................................Rock Size ....................... ..... S 3yt t b' 1g! Distance to nearest: Well Foundation ..........I.,....... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# .............•.............................. Date ................................ .) z i 1......................... . ................................. .........................nts)Septic Tank IS ecifY Requirements) .. ................. .......... Disposal Field {Specify Requireme f ..................................................................... ......................_.........-- ....................................................I.,........................ .......-•........... .. ................................. •-----..,....._.........•--..........................• --..,.......,.•----..........-----..........,.......-� e (Draw existing and required addition an 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-Lows, and Rulesand 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, 1 shoal not employ any person in such manner as to become subject to Workman's ompensallon laws of California.” Signed xu ..�.. ............................ Owner ... title .............................. ......::.......... ............................... .............. 1 (If other than owner) ! OR DEPARTMENT USE ONLY - 7. . APPLICATION ACCEPTED a ........ DATE .. .. Q �.,. ...... ........................... BUILDING PERMIT ISSUED .............:.......................................... DATE.....................................:...... .......................................... ADDITIONALCOMMENTS .............................................................................................................................................................. 4 :. ......'....... :.................... .............I...................................................................... ...Date.............. ........`:� ..x.1...1............ FinalInspection by, . ........... ........................................ . ..................... SAN JOAQUIN LOCAL` HEALTH DISTRICT 13 24ae.. CkA 7/72 3 M