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'! FOR OFFICE'_USE: APPLICATION iruR SANITATION PERMIT -------- ------- ----- ------------------------ ---------- 1134 No. (Complete in Triplicate) ermi Date Issued .-7v -------------------- I -- ------------ -- __- -- _ ______.______.____ 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 isad in compliance with County Ordinance No. 549 a existing Rules and Regulations: Z�,ro S_ 8 c�F�+✓�4 vL�. . �D JOB ADDRESS/LOCATIO - -�'/= ��'--, - ------ ----- - -------- ENSUS TRACT --------------- ---------- Owner's Name _.: . ------------------------------------- -------- -------- Phone Address ------�J a ---- -- r------(------ -------- -. Cit e_ --------------------------•-----.-. I Contractor's Name 6 -------- --- —p - - -- - -- -✓� _- -- __Y --.License # ��3��__ Phone ---------------------------•-- Installation will serve: Reside c [Apartment House'❑ Commercial ❑Trailer Court d: l `Motel ❑Other - Number of living units:------ Number of bedrooms ______Garbage Grinder ------------ Lot Size .__� __'4�----r—-c-=_ --- Water Supply: Public System and name -----=------------------------•---------------------------------•---•---------------•-------•------------- teg Y S �w _ Priva Character of soil to a depth of 3 feet: Sand'❑�'` Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam N - Hardpan ❑ ' +A dobe.E] Fill Material _.---------- If yes, type .-____.___.________.______ j (PI'ot 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 s epage pit\permitted if public se er is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK[' Sizeq_/;i---A----IV___. -_--- Liquid Depth ------q_____________ ( a Capacity 64___ ____ Type __ j Material( "�`- .,,_ No. Compartments ----- ....._. Distance to ne rest Well �______ - Foundation ________ 'w � ---------- --6- - !� '-`.-__ Prop. Line LEACHING LINE [P No. of Lines --____ - -------_s�--length of each line----------q4�--- - Total Length ---s�.�_-!�d___-•_--- � 'D' Box ---- ------ Type Filter Material -------S__k---Depth Filter Material ----------I_�f_____------------------ _____ , i f c S Distance to nearest: Well __________ _ ___ Foundation ____18_________.___ Property Line ___v__X &V SEEPAGE PIT [�• Depth --- ----- Diameter .:_ _� . Number ---_ __ ..M_._ ______ Rock Filled Yes No ❑ Water Table Depth Rock Size yR �_ ..f - -'� Distance to nearest: Well _____________�_�fa___.._-�-______Foundation __.__;_ ,�?__.___ Prop. Line ------------------- REPAIR/ADDITION ______.______.___REPAIR/ADDITION(Prev, Sanitation Permit# ___-----------------'________`.-1-------�-___ Date _______.____-�"•`� ) Septic.Tank (Specify Requirements)--------- __':__ Disposal Field (Specify Requirements) i " f -------------- ------- -------- ------------- ---------------------- - J l - - ----------- ---------------------- ------------------ - ---•- - - = --------• --------------------------------------------I----------------------- -____._i_________________________________________________________________________________________ --- ----9:_.-----------------------------------------------...----------------------------------_ . f (Draw existing and requirea-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: "1 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 Workma 's Compensation laws of California." —Signed- -------- BY -------`---------- --- - `------------------------ Title (If other than owner) ( t F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------- ------------------------------------------ DATE __ -- f-------- -------- BUILDING PERMIT ISSUED -------------------------------------------------- --------------DATE -------------------- ----------------------------------------- ---------------------- ADDITIONAL COMMENTS ------------- ----------------------------------------------------------------------------- ------------------------ - -------------------------------------------------------------------------------------------------------------------------------- -- --p- - -- ------ ---- - - ------- --- - -------- Final Ins ection bY ------------------------- --------- - ----- - --- - ------- .--r ---- --------------------------------------------------------- - ate SAN JOAQUIN LOCAL lf. •1 r' DISTRICT E. H. 9 1-'68 Rev. 5M