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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. r ----- -- - --- - ------------------- ----LJ------------------- This Permit Expires 1 Year From Date Issued Date Issued : Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal..) the work herein . described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .__ a2 ,_5-----./� _ �_ /�i1�A'r��-- - -- CENSUS TRACT ---'�'---=------ ------ �^- i7A_yZ_S-= ------ --- ------ ---- -- --------------------------------------PhoneOwner's Name Address ------ --------_. City �1A/ ` - %-- --- _ - _ ---:---- -- --- �. Contractor's Name _ 1 _7XPY1tr ---------------------------------------------------------License =-- ---��=".�G � ' . Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other ---------------------------------------- Number of living units:__I----- Number of bedrooms _____Garbage Grinder ---� ------ Lot Size '------------- Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private [� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [V Clay Loam ❑ Hardpan ❑ 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 seepage pit permitted i` public sewer is available within 200 feet,) PACKAGE TREATMENT_ [ ]_ SEPTIC TANK' [ Size ___ �. X_�-evfo__--__-____ Liquid Depth _7G' - p ��'�► -- --------------- Capacity 1-2-C''-C----- Typ _ '_7;n z__ Materiaaii W A-` No. Compartments _-;�.................. N Distance to nearest: Well ----f0-_-_-______-___-__._.Foundation I�-------------- Prop. Lineel �__ _�__. LEACHING LINE [Aj)' No. of Lines 4 ----------------- Length of each lin+s_d-C------------ .__-- Total Length Ire-en--------------- 'D' Box .-SType Filter Material YllL)f_A--------Depth Filter Material 1.9-el ________-_--_---------------- Distance to nearest: Well _- Q_ ----------- Foundation ----------- Property Line /�G.__r-_-_--.__--_ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ----_ ----_----------------- Rock Filled Yes ❑ No i❑ Water Table Depth --------------------------- ------------------Rock Size ----------- y------------------ Distance to nearest: Well _.__----------------------------------Foundation ____.__ __-_.._. Prop. Line ______________________ REPAIR/ADDITION(Prev. Sanitation Permit# -------- ---- Date _____-_---_______+_---_.-_._.-) T Septic Tank (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 or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signe - .___ Owner BY - ' 5 o Wil. ` -`..'. ( =-'- - �'i �� ' (If other than own�r� -- Title y .rlr -_ _ ____________ FOR DEPARTMENT USE ONLY ? — APPLICATION ACCEPTED BY - --- -------- ----- DATE BUILDING PERMIT ISSUED . _'__DATE _ -- .--------.----------_- ADDITIONAL COMMENTS --- - ___ - -------- ------- --------------------- -- ---- - -----------------R------ -- ----------4-------------------- - --------- -- ------- --------------------- -- ---------- --- ------------- - -- ---- ----- - ---•`---------------------------- --------- ---------- --- - ------------ ----------------- ----------------- - - Final Inspe2tic�nhy: ------------ ---Date --- .-------""--- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M