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r K FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------- ---------------------- --= Permit No. (Complete in Triplicate) , Date Issueds- _ll=: ________.__________________________--------------_______ This Permit Expires i 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 a d existing Rules and Regulations: 108 ADDRESS/LOC TION . ------- ------- �r� !='"` ""' ° �'"G .�1 TRACT ,I r - Owner's me i!�-G -4 ------------------------------- - ---Phone Address d -_ d-�_ _ City ------------------------------------------------------- - ------ II Contractor's Name ___ ________ - _________.License # 9-Sy-17:.x____ Phone _/ZZ 31417--- Installation will serve: i Residence ❑Apartment House❑ Commercial :❑Trailer Court i❑ i Motel ❑Other-------------------------------- ------ Number of living units:___.:_. Number of bedrooms _-____-.Garbage Grinder ___ Lot Size _®©_._________________ ______ Water Su 1 1 I! - me,- - _ Private -� - pp y:�Public_S stemTan Character of soil to a deptli of 3 feet: Sand'[]_Silt❑ Clay Peat 0 Sandy Loam -0 Clay Loam�] F Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot ____ _ .__ __ _____(Plot plan, showing s1z6 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 pubic sewer is available within 200 feet,) i PACKAGE TREATMENT [a�J SEPTIC TANK'[ASize'��.?�_S ___ ------------ Liquid Depth _----------•--------•---- l s C`pacity l � - Typ ��Mafierial_ ___ .No. Compartments _--_-_ ''._.:.�. ,,,Distance to nearest: Well ,1,66------------------------Foundation 14--1--------- Prop. Line LEACHING LINE [1KN'o. of Lines ---A_G'�---------_- - Length of each line------7d-------------- Total. Length 07 4--- ( 'D' Box _ _/-_____ Type Filter Material s`_ _Depth Filter Material''-/ ... ...... ____ Distance to nearest:'Well ------.---- Foundation Q.------------ Property Line __ ______ -------------- SEEPAGE __________SEEPAGE PIT De th ___--___- Rock Filled Yes No [ l P -------- ----------- Diameter --------------- Number -------------- --- ❑ 0 !Ik 1 Water Table Depth -------------------------------------------------Rock Size ------------ ------------------- I�, Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -----.----..__._---_.. .IMS REPAIR/ADDITION(Prev. Sanitation Permit# _____.__.___-------------------------------- Date __________________________________I Septic Tank (Specify Re'Iuirements) -------- I---------------------------------------------------------------------------------------------------- -------------•--------_-- Disposal Field (Specify.�Requirements) ---i.)---------------- ----------------------------------------------------------------------- ------------------ 4 ----- - -=---------- - ----------- -- ---- - _ - �. :- --------- ----- -r - - --- ---- ------------_-- I ' , (Draw existing and required addition on reverse srde)� I hereby certify that 1 hale prepared this application and that the work will be done in accordance} with San Joaquin " Count Ordinances State taws and Rules and Re ulati f th o i County I g ons a e San J aqu n Lacaf Health IDistr�ct. Home owner or leen- sed agents signature certifies the following: "I certify that in the performance f the work for which this permit is issued, I shall not employ any person in such manner as to bec sub'echto-WI kma s CompenS5q06ws of California." Signed - -- ----------- ----- ----- - -- ---------- - Owner By -----•------------ ------------ t ` --- -----Title -- ,;,(If other thane owner FOR DEPAV T USE ONLY a� APPLICATION ACCEPTED BY ------------------------------------ - - - - - -------- --------- ------------------------- DATE ----- 9 BUILDING PERMIT ISSUED[- --- ------------------------------- -------------------------- ---- - - ----------DATE ------ -------•----- ------- ADDITIONAL COMMENTS ------------------------------------------------- - -------------------------------------------1 --------------------------------------------------------------------------------------------------------------------------------------------------------------- ft ------------------------------- ----------------------------------------------------------------- Final b Inspection I,'_ P Y - ----------- - --------.Date Q------'---_-9------------------- SAN JOAQUIN LOCAL HE LT 157RICT # - E. H. 9 1-'68 Rev. 5M `