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FOR OFFICE USE: APPLICATIC* FOR,.SANITATION PERMIT ----------------- 0------------------------- Permit No. (Complete in Triplicate) ---------_---------- -- I - 2 "�_ Date Issued _-_„1--�._ .,/ ___---_--__-_---- --- 1--�________-- 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: JOB ADDRESS/LOCATION . __ _ -1_ `c l't u STi N__-_- 11---------------------------CENSUS TRACT -------------- __�_--S0 •. Owner's me -----------NU-N- �� ' ____AR_rM_ __SPhone ---------------------------------- Address--- �-Q------ 1_0_Uj e Contractor's Name ----QWNFZ?_�=-------------------------------------------------------------License #'---------:-------------- Phone .---------------------_.------ Installation will serve: Residence ❑Apartment House[] Commercial ❑Trailer .. 7/-114 Motel ❑Other ----------------------------------------- Number of living units:_______ Number of bedrooms 3------Garbage Grinderyp------'Lot Size _AGR _ --�-c---------------- Water Supply: Public System and name ---------------------------------------------------------------------------------------------•----------- -'--Private �. Character of soil to a depth-of 3 feet: Sand❑ Silt F,1 Clay ❑ Peat Sandy Loam k�I�Clay Loam ❑ HardpanAdobe ❑ Fill Material AJ----- If yes, type -------------------_____-I (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 seepa pit permitted if public sewer is available within 200 feet,) rr PACKAGE TREATMENT { ] SEPTIC TANK'[r} Size---7_t!_140_JS__ �—! _________ Liquid Depth ' ___1 -------------- Capacity _____________Ca acit Type ~ ECSMaterialTo. CompartmentsZ ,......... 6 ----------------Foundation --- '"'7.--- Pro Line ---- _'f----- � stance to nearest: Well _.____�� -�--- ��- p• L` � LEACHING LINE VOeNo. of Lines -------�----- -__ Length of each line------6 ---------- Total -Length �------!--------_...... 0 'D' Boxes_ Type Filter Material Depth Filter ger Material _ -----------I---------------___ t______________ Distance to nearest: Well __ lO__d_�_f Foundation ---------Property Property Line i SEEPAGE PIT Depth � ___________ Diameter X Number _____- - ,__________ Roc Filled Yes No ❑ << Water Table Depth ------------------------ $01' r- - _ --------Rock Size----- -- t- ------- , Distance to nearest: Well ___�D __r_" —---------------Foundation ___,llJ__"f'__ Prop. Line 5___�..... may REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ,_________-____________________) Septic Tank (Specify Requirements) ----- ----p- /I Field (Specify Requirements) ------ --- ,/---I-= "- _ ---- - ----- ------------------------------ ---------------------------- Disposal �i ---------------------------- ------------------------------ ------------------------------------------------------------------------------------------------------------------ ------- ---------------- (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. Homy owner or licen- sed agents si ture certifies the following: "I certify t t perfo ce o e work for which this permit is issued, 1 shall not employ any person in such manner as tobec)me sul ct to Vfforkma Compensation laws of California." -------- --- - ---------------- --- Owner Byr - - - - - - - - - ---- -----------------------------------��--------- Title - - ----- (If other than owner) `a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------� -0-------------------------------------------------------------------------. DATE ------- ----7{---- BUILDING PERMIT ISSUED ---------------- - --------------------------------------------- ------- ---------DATE _ ------------------:--------------- ADDITIONAL COMMENTS -- ---- - --- --------------------- -------- -- ----- ----------------------------------------------- ------=----=--------------------- -------------------------------------- ---------- --- --------------------- --- ------- - -- --- --------------------------------------------------------------------------------------------- --- ---------- --- - - -- -- ----- - - -- --- ----- -- -- ----------------------------------------- - - - - -- - -- - - -- ----- - - - --- Final -- s ection b ------ --- --- Date -� --- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M