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FOR OFFICE USE: _ ------------------------------ APPLICATION FOR SANITATION PERMIT ---------------------------------I-f (Complete in Triplicate) Permit No:�Q_-"7 ff This Permit Expires 1 Year From Date Issued Date Issued/e__/677 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulationsfein JOB ADDRESS/LOCATION ____ p �.� .,.... _ lw� R CENSUS TRACT Owner's Name Phone �f7-� Address ------ ------------ -- City :--,_74:2 �ICTU �' - Contractor ;Name "__"� ,,�.� �,�f��'�-"- - --.License # �� Phone Installation will serve: Residence ❑Apartment House�❑ Commercial:❑Trailer Court i❑ r Motel ❑Other --_----------_--- -- -- - t - Number of living units:.__ _�"_"-- Number of bedrooms "_" ___Garbage Grinder --"/1J0_ Lot Size "��"/QC�'� S' ater Supply: Public System and name -""__"_-_-__ - ----'---- I - �---------- -- - 4(Q - -------------------------- -------Private Character of soil to a depth of 3 feet: Sand' 51t❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 21'!" Hardpan ❑ AdobeQ Fill xMaterial ------------ If yes, type -------------------------- (Plot ---- ---(Plot plan, showing size of lot, location of system in relation to' welds, 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,J ({� PACKAGE TREATMENT [ ] SEPTIC TANK SiZey r 1 ,y -Y r �� ------------- Liquid Depth ----- ------ Capacity _ -I/O_.:-- Type1.Eew - Mater aIC"—r�il�L,� No. Compartments --------- Distance to nearest: Well __ - - 7-------------------- - O_ Foundation l Prop. Line --1--- ---- -------- LEACHING LINE P�1 No. of Lines ___""__ l l ---.__ Length of eadh line---------14_0-------- Total Length -" ------- 'D' Box y -'Type Filter Material �. til > � Depth Filter Material _"� -/�---------------•------•------- 'N 4 w 4 ' `�- Distance to nearest: Wel! -_- """"___ Foundation -"--./f_-____ �i Property Line _- -- -------------- SEEPAGE PfT fJQ Depth. ---------- Diameter_ ----� --J ----- Number -------/----- ------------- Rock Filled YescO No 0 s Water Table DepthY--O-- ------------ ------- -----------------Rock Size Distance to nearest: Well ,jQQ"-�_ - 1Q� - ----- ----Foundation - -----. Prop. Line T_/----_--------- Se i tic Tank ION(Prev. Sanitation Permit�# ""._-_.___""-___"_ - ---------- Date ----------------------------------) REPAIR/ADDITION Septic {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 sed agents signature certifies the following: or liven- "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner C15 to become subject to Workman's Compensation laws of California." SignedOwner -------------------------- By -------- - { - ----------------------------------------------- Title ----- - {If othef than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ BUILDING PERMIT ISSUED - -__ - --- - - --- DATE -- D --�- !� --- - -------- -- --------------------------------------------- ---------- ADDITIONAL COMMENTS -------_-""-- -- DATE "..----.------------------.- ---------- -- ...... ------- --�o- - - ------------- -------------------------------- -------- ---------------- _ o -- - �-- cel- - - � _- -- --- ---------- --- Final Inspection b -------- - p y= CS--�---J---.--�---------=------- --- ------- -----•------------- ---------- ---------- --- - --------------.Date ------------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,