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FOR OFFICE USE: o APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. --7_Z..S-�-- -------------_-_ 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 install the work herein described. This application is made in com liance with County Ordinance No. 549 and existing Rules and Regulations: -��_� --------------------CENRACT ------- --------- JOB ADDRESS/LO ATION .A.t---/-_._-------_0 G' Owner's Name _. _.t.,10W,2,2/ems Viz. - Phone - -- : --- Address --------- --- - -------- ----- l''e/-- -- ------------ City _�.'��_I '^�---------- J Contractor's Name -- --- 7 ------ - License # 7/�j Phone / Installation will serve: Residence B<Partment House-E] Commercial :❑Trailer Court ;❑ Motel ❑Other -------------------------- Number of living units:- -------- _ Number of Brooms __._._---Garbage Grinder t�_- Lot Size _____________ Water Supply: Public System and I ame -__ _____� _ _._ _ Private -- ------ ---------•-------- ----- Character of soil to a depth of 3 feet: Sand'[:] SWt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe il! 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 if public sewer is avoilable'within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAN I�] -size-_.�_-Y_�___ _ ___�______________' Liquid Depth _.'�_.�_..z.__._ Capacity �t ------ TypepAt _ Material-- o No. .Compartments ----------- Distance -to nearest: Well Length each Foundation _ .�__------_ Prop. Line __ �'_____________ a LEACHING LINE M No. of Lines ------------------ g line.--_ __... _�__--.- Total Length J` 1 -----------•----•---- c 'D' Box e.�_ Type Filter Material 1.. ! -Depth Filter Material _.__ _ ._----------------------------•- f Distance to nearest: Well --------r--____._ Foundation0 -Property Line, ___________ -_ SEEPAGE PIT X1 Depth .__.� ---___ Diameter`?.�_-----__ Number Rock Filled Yes ❑ No CJ Water Table Depth ----------G-t i-----':._-__ „=:.____Rock Size =.��=�� ---------- Distance to nearest: Well ----°_ ........ .....Foundation -------- Prop. Line _j_.......____ REPAIR./ADDITION(?rev. Sanitation Permit°# -------------- '4 ------ Date ------------- i Septic Tank (Specify Requirements) ----------------------------------------------------------------------------------------------------- ------------- 'Disposal Field (Specify Requirements) --_-____-_ --------------------------------- ---- ----------------- _ -----------••------- ---------------- ; certify pre aced this existing istl cation required d addition -- e tion on reverse side) I herebycern that I have p pp work will be done in accordance with San Joaquin County Ordinances, State Laws, acid 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."- Signed alifornia."Signed --_=------ ---------------- ----------- --- ----------------- ---- -- ----- - - ---- Owner BY =Title (If other than owner) ; I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ =_'=",== -. cad/ le ------------- ----------------- DATE 7 ---------- BUILDING PERMIT ISSUED ----------------------------------------=---- - ,--------------------------DATE ADDITIONAL COMMENTS --------------I_ -- ----------------------- ----------------------------------------: ------------------------------ -----------------------•--•-•----------- 1. ---------------- -•-------- s --- ----------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- k - Fi -- In -- b ---------------- �a. Final Inspection by —------------ - -- - Date ------------- -------------_-:----- --- -- 1 AN JOAQUIN LOCAL HEALTH DISTRICT _ E. H. 9 1-'68 Rev. 5M. µ C