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FOR O F CE YSE: s J �,� o APPLfCATION FOR SANITr4TI64*&MIT . .. Permit No. - .�...�._._.. _� . -- - 1 ----- ---------------------------------- y Date Issued--�- --:-�0 -------------------------------_-_•----- _---------- This Permit Expires 1 Year From 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: I .JOB ADDRESS/LOCATI N ----------------- --.... -- ..---._CENSUS TRACT + - ------------ --..---- J ,,.....,.� . ._. Owner's Name --- ' f�`� 7�� 1;2 9e.6 ----------- ----- ----------------- Phone A----------------- --- ZLA Address / 5�' i Jf -----------------------=----------- City --- i `�------- ------------------------------ - ---------------- ------ `- -------------- Con#,actor's Name ---------- --_- -- License # jc �Phorte _ � -=------- ---------- Installation will serve: Residence ~ artment House-E] Commercial :❑Trailer Court ;❑ ` Motel ❑Other -------------------------------------- of living units:_____-.__ Number of bedro s __Garb ge-Gri'nd r _ _ Lot Size_ ---------------- Number Water Supply: Public System and name ----___--- -- -- � — --- `'------- -------' -------------------------------Private ❑ Character of soil to a.depth of 3 feet: Sand'❑ Silt[] Gay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ AdobeX Fill Material ------------ If yes, type ------------------'-- -__-- a ' a � (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 'f,public sewer is available within 200 feet,) 1/ . PACKAGE TREATMENT [ ] SEPTIC TANK' ,. 5' e_^k ___ -�:__` _ ___G/. Liquid Depth f� q p Capacity . _ -- Type steric l t' ado. Compartments ------ `...__... Distance to nearest: Well -__y� _-___�_ :-=`-.Foundation --- Prop.Prop. Line C3 ------------------ 'D el ' LEACHING LINE No. of Lines �.t _______________Length-of each ]ine�-_ - "_ , `_ Total Length� ,.-_ ___--- ____De Depth Filter- Material ----'D' Box �!�_ Type Filter Material JA�._ p `� Distanc to nearest: Well ___'~' ;_-_-_____ Foundationf _____________ Proper 'Line __-____________.. .._. ______ Dia'meter _____ ____ Rack Filled Yes No i❑ t �J ✓' SEEPAGE P17 ; Depth �.___ __ _ �:___`____ Number _____ _ _ ,1 jJ { :{ Water Table Depth Q.k - "'f Rock Size '= f f- Distanceto`nearest: Well -------Tr:-.7�-----------------------Foundation Line An REPAIR/ADDITION(Prev. Sanitation Permit#':_- -- ---- .----.- - ------------- Date------------------------------- °---- I , Septic Tank (Specify Requirements) --- ----------- r:;---------- ----------------------------------------------1.........==G<-----------.-:< -------------------------- 6'V Disposal Field (Specify Requirements) ----------------------`i=-------=-----._------------------------------- ---------- ------ __ ---.-----------------`---- ---- ------------------------- -----------------------------------=------------------------------------------------------- ------- ------ - -.---- i --------------_------_------------------------------------------ _____ ____--__________ __ -- ---_________-________ ___._.__ -------------- -- (Draw existing and required addition-on-reverse side) I hereby certify tha� I have prepared this application and that.4the work will be done in',accordance with San Joagitln County Ordinances, Estate Laws, and Rules and Regulations-,of the�San Joaquin Local Health District. Home owner or,licen- sed agents signaturelcertifies the following: s ;= .•:1 "I certify that in the-.performance of the work for which this permit is issued, I shall not emp_IQy any person in such manner as,to become subject sto Workman's Compensation laws of California." -' Signed ------- -- --------------------------- Owner / • rj By ------------ --------- ---- - /lam ------------------------ Title (! - (I r an-Ad E FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y --- -- S�,�----=--------- -- --------------------- DATES a BUILDING PERMIT ISSUED ----- --- ---------------------------------------------------------- DATE - ADDITIONAL COMMENTS ------ --------- --- ------------------- ;---------------------------------:------- - -Tt-- ------------ -------------------------- -- ?D- -a '1- p � ---- [ ------- -------------------------------- �-- �-� ---------------- - - - -----------------:---- ------------.Date --�-�-�-r]�--[- - -------- Final Inspection b - SAN JOAQUIN LOCAL HEALTH DISTRICT _ E. H. 9 1-'68 Rev. 5M