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i . FOR OFFICE USE: PP- GA1161 FOR SANITATION PERMIT t _ 4 _Permit _ ! (Complete in Triplicate) ---------=---- = - ----- t -- -=- Date Issued - ---- --------- I •r _ �,. _-- ---- ---_-_ This Permit Expires 1 Year From Dale Issued J-Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein r described. This application is made i1n compliance with Count Ordinance No. 5.49 and existing Rules and Regulations: �- --------CENSUS'TRACT --------------- -------- JOB ADDRESS/LOCATION"'r- ------------ - ------------------- ------------ ----5 -- l� ` --Phone ' 7 j ] Owner's Name -T=? -P141--`'c �'-- ---------------------P- ---------------------- ----------- ------- ----•--- Cit �'�.-Ct� ------------------------------- ----------- R, ---------- Address --�.��-�_ -��----�--- - ----CI�`�-------- ----/-)-;------;---- Y - -- - --- ,, /�� __ License # S�- '7--- Phone -��---�'�/_l_.�-- . Contractor's Namer -- Installation will serve:. Residence �-Apartment House❑ Commercial Trailer Court '❑ f Motel ❑ Other ---------------------------I---- ----- Number of living' units:____ ___ Number of bedrooms ----V_=Garbage Grinder Lot Size d @ \-' _--Private' Water Supply: Public system and name -- ----------------- s Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay El at E] Sandy Loam ❑� Clay Loamf �,R. Jam' Hardpan ❑ Adobe El fill Ma#erial .. If yes,type - J„ (Plot-plan, showing z6 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) ' SEPTIC TANK' Size ------- Liquid Depth -----------------------•-- PACKAGE TREATMENT [ ] [ ] r„ S Capacity �4 Type .____ _ -- Material__C0mPm-z_uA No. Compartments Distance to nearest: Well ------------------------------------Foundation ----------------- ---- Prop. Line ------------- -------- LEACHING LINE [ ] No. of Lines ----.-- -------------- Length of each line----:-�Q ,. - Totd1 Length ----2-74----------- I. 'D' Box - .Type Filter Material __LY --------Depth Filter Material __,Jr---------_---------------- ....... Distance to nearest. Well ---.�_0-.P--------- Foundation -_ L_ .--- P ---_ Property Line -----J----- ------- ---- C SEEP AGE PIT [ ] Depth ---�-i��-- Diameter Number ---------3--------------- Rock Filled Yes No .0 •13 -p_,44 Water Table DepthRock Size ----[_.�-------- --------- ------------------------------------------------ 33 jC a 5 Distance to nearest: Well ---`,7-i�----------------------------Foundation ---(-0----------- Prop. Line ---------_--- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) --- --------------------------------------------------------------- ----------------•----------------------------- Disposal Field {Specify Requirements) --------- ------------------------------- --------------------- ----------------------------------------------------------------------------------------------------- -_� -T- . . ----------------------------------------------- w - - --------------------------------------------- ------s (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 shad not employ any person in such manner ! as to become subject to Workman's Compensation laws of California." Signed ------------ ------- --------------------------------------------------- Owner ti"T� ---- ----------- Title ------------ ---------------------------- - --------------------------- I (if other than owner] # FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- -- -- --- ----_ -------------- ------ -- -- --- . •---_. DATE ..Z(--1� - 2-�---------- 1 BUILDING PERMIT ISSUED -------------------- ----------:- --DATE ------------------------------------------- --------------------------- -------------- _ ADDITIONAL COMMENTS _--- -- __-- ----- - ------------------ -- ::_==== a � ____-__- _�M-- ____--_------ __________________________________________ ------------------------ - -__ _ __ ___ _____:_: ------------ ------------------- ------------------------------------------------------ ----------------- ---------------------- - ---- ---------------------------------------------------- ----------- ---- Final - _---- 8 � ----- Final Inspection by _-____- ._.- _- - �D.atb':'�~�- � - SAN JOAQUIN LOCAL HEALTH DJSTRICT E. H. 9 1-'b$ Rev. 5M