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F OFFICE USE: 1 _ - APPLICAVON FOR SANITATION PERMIT -------------------- Permit No, . 2 �j t (Complete in Triplicate) --- This Permit Expires 1 Year From Date Issued t. Date Issued _.__ __�_-��___� Application is hereby made to the San Joaquin-Local Health District for a permit to construct and7nstall the work herein described. This application is made in compliance with County Ordinance No. 549 and.existing Rules and Regulations. { - JOB ADDRESS/LOCyATTION 10 --;�' ------G i It J� �l1,Q---- ----------..CENSUS TRACT _CZ( -1(O 70e ' Owner's Name --f /------ / --------- ----- ------Phone ---•- ------------ Address ---------- ' _ City -t� lr / ------- 'OCA 'Q , -01,V"OVC`---------------`--------- Contractor's Name --��C� ----S C---S_.�' ---------s-----------------License # -7.7- - Phone _�1,1__d ep� / . Installation will serve: Residence O Apartment House-El Commercial ❑Trailer Court i❑ l Motel ❑ Other ------------------- ------ ----------------- Number of living units.----/------- Number of bedrooms .__.____Garbage Grinder / _Q__-_ Lot Size _ ysX_ ________.__. Water Supply: Public System and name -----------------------------------------------------=----------------------------------------------- ------Private ❑ Character of soil to a depth of 3 feet. Sand'[:] Silt❑ Clay [:] Peat❑ Sandy Loam -❑ 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.) Q� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) `4 PACKAGE TREATMENT W, SEPTIC TANK Pq Size__ _ �_ - - Z ---------•------- ---- Liquid .Depth -,!�- - - ------•------•- CapacitylP0�_(_.__ Typed fV57--- Materialt�4 e—/4cE�,,�- .No. Compartments ................. i. Distance to nearest. Well _______________________Foundation ----Lv------------ Prop. Line ........... LEACHING LINE No. of Lines ____, ------ Length of each line.... f� LY_J11_./___- Total Length ,_AV____________________ D' Box/_O_------ Type Filter Material ao!aC -------Depth Filter Material _. /_r------------------------- -._._...... 1 Distance to nearest: Well ___~_______________ Foundation ----------------- Property Line. -------------- SEEPAGE PIT [ ] Depth --------------------- Diameter ---------------- Number _.__.`. -_ - Rock Filled Yes 0 No i❑ Water Table Depth -------------------------------------Rock Size ---------- --------------------- Distance to nearest: Wel! -----------------------------Foundation -------------- -_--- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________) Septic Tank (Specify Requirements) ----------------------------------------------------------------------------------=------------------------- ------ DisposalField (Specify Requirements) -------------------------------------------------------------------------------------------- ------------------------•--------------- ------------------------------------------------ -------� -------------------------------------------------------------------------------------------------------------------- -- 1 ' i (Draw existing and required addition on reverse side) 1 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 erformance of the work for which this permit is issued, I shall not employ any person in such manner as to become ub! t o orkm n's Compensation laws of California." Signed _.. -- - --- ------ - ------- --------------------------------------------- Owner i t By --------- -------- ------ - ------------ ---------------------- Title -------- ---- ---- - -------------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-- -----U_ 4 --------------------------- _ _ _- -- - - ------------------------------- - - DATE -�1�-��7-�-- ---- ---------- BUILDINGPERMIT ISSUED ----------- i-----------------------------------------------------------------------------=--------------DATE ------------------------------------------ ADDITIONAL COMMENTS -------------- ---------------- ------------------ /� ----------------------------------- -- - --------- ------�-'--------------- = ---- ---------------- -------------------- '-'�- ----------------------- ------------ ------- j I - ------- - FinalInspection by: ------------ A- �-----------------------------------------------------------------------------.Date ` `�& 7-f----- ------- SAN. JOAQUIN LOCAL HEALTH DISTRICT G E. H. 9 1-'68 Rev. 5M.