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" FOR OFFICE USE: " 10i F,%. APPLICATIOPL-FaA `SA£LITATION PERMIT .. `' ---------------------- (Complete in Triplicate) Permit No. _ 6 _ This Permit Expires ] 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/LOCATION --- DV�t�-� u,t -------- --------- ----CENSUS TRACT Owner's Name P, ___ ----------------- -- ----------------------- -------------- - ----------Phone ._ b' 6 s Address ---.-1.05- :S rR1 - L Cit --- ----- ----------------------------------- ` Contractor's Name I' --------------------------------------- ---------------License # ----- --- ------ Phone --------- -- Installation will serve: ResidencexApartment House,0 Commercial [-]Trailer Court ;❑ ,.. Motel ❑Other a. Number of living units:.---I------- Number of bedrooms _ ___--_Garbage Grinder --- ----_- Lot Size ----_1_N;?0;Zt- ater Supply: Public System and name _____ _ - ----- - Private - ------------------------------------------------ - Character of soil to a depth of 3 feet: Sand,Ej Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes, type ---------------------------- 1 (Pl'ot 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, PACKAGE TREATMENT [ 7 SEPTIC TANK ' r� C l Size - x 0--K-5----------------- Liquid Depth y --------- { Capacity a�--�-��;1- Type ---------- --------- Material----------- -------- No. Compartments --- .1 L') Distance to nearest: Well _-_ Q_---- -- ---------- ----------Foundation -_�{?"k---------- Prop. Line ----�5--�--+------•--- LEACHING LINE [ ] No. of Lines -;;�------------------ Length of each line_ -, -- --- i --.-_ -_ Total Length ,_�_'_4 'D' Box .__V----- Type Filter Material ---_Depth Filter _Material __-_.13'-f1 Distance to nearest: Well ._ i - -••----•-------•------ —TOz --------- Foundation s `` _-- __---_ Diameter �,,,r�r Number _--__J_ "{ -------- Property Line. --- - SEEPAGE [ ] Depth -_lY - Diter L1.'9_ - cP---- _ ---.- ____-__ Rock Filled Yes;i'� IVo �❑ Water Table Depth -__---100/-}- -----------------Rock Sizef .a Distance to nearest: Well _-100---_}-------------------------Foundation - - - ----------Prop. Line __. ____ ,__ RIEPAIR/ADDITION(Prev. Sanitation Permit# ------- __ -__ _______ -- j - ------- -------- - Date ----------- --=--------•- 1 Septic Tank (Specify Requirements) ----------------------------------- ---------------------- 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 cei tifies 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 r as to become bject o Wor an's Co nsati.on laws of California." Signed x-__ - =�---- -------- ------------------- ---- caner BY - - -- ---------- Title ------------------- (If other than owned -------- --------- ------------ FOR - ---- -------- -------- --- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ---- ---------------- t - BUILDING' PERMIT ISSUED -- -- ---------------------------- ------------ ---------------- DATE --�_- -'1�---------------------- DATE ADDITIONAL COMMENTS ____ -- „�.� � __ - _ ---- __ i!-- --- - --'-"tom o �� o sQ►-[ems �o W� nirs Finale ns ection b - ��'�-- ---�---- ---� - ----- --- -�, ----�-'`'- p -------- -- - -------------------------- - - -- -- - - - -" ---- ---.Date ---= - -- , _q-t--------------------SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M A► * i1�ti 1��Co1!