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d FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------ (Complete in Triplicate) Permit -- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 J__.��__O L-l-------F-_________F_U_V A0_�---------------------------CENSUS TRACT -- --- ------ Owner's Name --------------G4-aRR-- --------IS ------------------------------------------------Phone ------------------------------------ Address _30o -)--- ----- -WABD-2--------------------- City ------OAK 9_E' -------------•-----•-----•------- Contractor's Name ---- _Nl ---- ------- +f - -- ,- -------------License # ---------.--------------- Phane _______-_____._________------ Installation will serve: Residence partment House❑ Commerciaf ❑Trailer Court ❑ Motel ❑Other ---------- n Number of living units:__..____. Number of bedrooms ��-Garbage Grinder�� Lot Size _!1-C�_f_fG:1�--__-__-_ Water Supply: Public System and name ----------------------------------------- -----------.--.-.------.-------..__..---_.__-------Private ' Character of soil to a depth of 3 feet: Sand'C Ut❑ Clay ❑ Peat❑ Sandy Loom .&/'Clay Loam ❑ Hardpan 2r Adobe ❑ Fill Material ___________ If yes,type ____________________________ (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 seeps pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size_YXJei&_ ____-_____.____ Liquid Depth 5------------ Capacity ------• _.Capacity _150O____ Type PiiiIE�CAS1`Material(fQ!� CET`No. Compartments ___7 ,--.__---- Distance to nearest: Well ---- --- ----------------Foundation ....A0---(------- Prop. Line ..._._.__- O� LEACHING,LINE"=' [ No. of Lines -----r�- ------------ Length of each line,,------leo--- ------ Tota] Length f 'D' Box "" _ Type Fitter Material. �_G ___Depth Filter Material ______ ---------______________ ` �"'� ___f�___"�____ Property Line Distance to nearest: Well !��•__:_________ Foundation ________.__-4- SEEPAGE .. SEEPAGE PIT Depth __1',�_�______ Diameter 1X` Number ______� //X- Rock Filled Yes ®-�N0 C] Water Table Depth ------/-�---- --------------------Rock Size �y,_-��--f-- - �r Distance to nearest: Well ----------Foundation ___/ ______ __ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit#.^-------------------------------------- Date ______.._______.___.______________) Septic Tank (Specify Requirements) -____.______^_____.- - -------------------------------- Disposal Field (Specify Requirements) -------------------------------------------------------------------------------------------------------------------------------------- - ------------------------------- ------------- ----."`-_..------- --------------- -------_----•---------------------------------------- ----------- ------- = (Draw existing and required addition on reverse side) V 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 Iicen. sed agents s' nature certifies the following: : .r "F certify t in the pe r nce of the work for which this permit is issued, I shall not employ any person in such manneg as to beco a subject to kmon's Compensation laws of California." Signd - - -- - �- - -- -- -- - ------ -- - ----------------.__. Owner By -- ----- - --------------- ----------------------------------- { ' ` *}.Title •:� -------------- (If other than owner) '�„ A. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ 1 ------------------------------------ ----------------------------------------" DATE ----- BUILDING ---BUILDING PERMIT ISSUED ---------------- ------ -------------------------------:-------------------------------------- -------DATE -------- = f ADDITIONALCOMMENTS ---- ----- ------------ ------------------------------------------------ - - --------------------------------------------- ---------- ----------=--------•-•-------------- ______________________________________ _____ _ _______.___ _._. ____ _ _______._________.____________._________________.------------------------------------ s ___________._____________________ __ _ __ __ _ _ ------------------------------- __ __ _ _ _ ` __ Final Ins _._ Date ` SAN JOAQUIN� LOCAL HEALTH "DISTRICT t r E. H. 9 1-'68 Rev. 5M