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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT __- -------------------------- (Complete in Triplicate) Permit IVo/_'_11.� J --------=---------------- ------------------------------ !4 ---------_----------------- -----" This Permit Expires 1 Year From Date Issued Date Issued 7/ Application 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. 5J9 and exi5flng Rules and Regulations: .w A JOB ADDRESS/LOCATI N"`. _-- ® -- -- - E SUS TRACT ---------------------------------------- Owner's Name Phone Address --- . i ------------------- City ------- Contractor's Name ----- _:_ _. � .. '. ----� --------------------------.License # ,��_-3_/ Phone --T - Installation will serve: 4 Residence ❑ Apartment House❑ Commercial : Trail6r-Gewt m b Motel E]Other ------------ ------------------------------- Number of living`?�units:___ .-"_ N of•'bedrooms�_-_--_ ara Grinder /W_�` J 9 /�' --- Lot Size - � ----------------------- Water Supply: Public System and. nameFIfF)4----- ------------•----------------------------------------------------------------------------PrivateX Character of soil to a depth o 3 feet: Sand'0 Silt..O Clay ❑.IkPeat❑ Sandy Loam' Clay Loam ❑ ii Hardpan ❑ Adobe,'❑ Fill Materially - ------ If yes, type -------------- (Plot -----------=(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 pub] sewer)s available within 200 feet,) PACKAGE y Ti2EATMENT [ ] SEPTIC TANK Si a-- - ?~J Liquid De th --------._""-- -------------- - q P L Capacity/9A_ _"___ Type __ Material_^%'_- ---- No. Compartments -------------.. Q ' Distance to nearest: Well ---Foundation __1,4f -_ Pro LEACHING LINE No. of - -- ---- ---------- ------ p. Line _,��.---___------ LEACHING -- -- . , D' Bo Type ----V"... __ -____ Length of each line." . ��---------- ------ Total Length �� --------------- � ' / bistbnc Type Filter Mate�i�` Depth Filter Material !! "" '--------------- --_._"__.. N to nearest: Well - _ Foundation / --- --__-__ I! � � ------- - - � ----- Property�Line ----.-------•----- °. SEEPAGE PIT [ ]' Depth ------------ Diameter ________________ Number .-------:---.--.--__.____ Rock Filled Yes [3 No C) Water Table Depth -------Rock Size -------------------------------- a sr Distance to nearest: Well ------- ---------------------------------Foundation -------------------- Prop.Aine ----------------- ADDITION(Prev. Sanitation P ---•- ` REPAIR . anaton ermit# -------------------------------------------- Date -------------•-------------__-----1 / - Septic Tankk-(Specify Requirements) ------------- ------------------------------------------------------------ Disposal Field (Specify Requirements) ---------"------------------------------- --------------------- - - - ---------------------------------------------- - �� r ------------------- --------- -- --------------------------------- t �( -----Draw existing .requ - =-----------------------------------�`----------------------------- g ed 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;'i and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies thefollowing: "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." l" I Signed ----------------- " wow s►rr Owner ih -- ------------------------------ BY I f _.. _ 1,'t 17 Title p. 6 -✓v-.A------------------ ---------- (If than owner � IL FOR DEPARTMENT USE%ONLY ' APPLICATION ACCEPTED BY ------- DATE """ _ ._ + " _�____ ------------------------------------------------------------------------ --------- BUILDING PERMIT ISSUED 1 #------ -- DATE ADDITIONAL COMMENTS --------- ------------------------------------------------ ------------------------------------------------------------------------------------------------------ ------- --i ---------------------------------- d . ---- ---------------------------------------------------------------------------------------- / Fina Inspection by: ----- - - -- ---------- --------- ------- - Date ---- ---- �� SAN JOAQUIN LOCAL HEALTH DISTRICT - E. H. 9 1-'6$ Rev. 5M " i � .