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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------- ------------ (Complete ______ _ �' (Complete in Triplicate) Permit No. ._7_._ _��_ _'2' ---------=----------------------------------------------- --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is madin compliance with County Ord.ina No. 9 and existing Rules and Regulations: JOB ADDRESS/LOCATION .r��.�l��a.�t�--j`'�Q ��- ----F }---A--e A- �....--C RA,.P-.---CENSUS TRACT -----S--41-------____________ Owner's Name _.. WWj_e ---------Idll/y1 iY- ----------------------------------------------- -------Phone t3 �• /�t Address 4'�----Rd ------------------------------- Cit /fir' _ ,o Y ` ,Ilfc, '?1r----------------• --- Contractor's Name . I� �_ C.SjI _ ,yto_r�r� `t�4,..___.License #1f,17.d-of--_____ Phone Installation will serve: Residence$K Apartment House-❑ Commercial ❑Trailer Court ',❑ MotelOther ------------------ ------------ -------- t Number of living units:________ Number of bedrooms ____ -- •____Garbage Grinder ------------ Lot Size - _ . Water Supply: Public System and name ----------------------------------------------------------------------------------------------------------------Private,$ r Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 39 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 if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ze--------RQ�_mA,------11104"6_ Liquid Depth -------------------------- Capacity ----------------- -Capacity /.5-0-0------- Type , ,e?z6Z0a Material__1 4r44'R^&F No. Compartments -------V------------- 1 Distance to nearest: Well -----C40._____ (A________________Foundafiion ..-��____..___..- Prop. Line ___��_____.._... 1 LEACHING LINE No. of Lines -------2------------- Length of each line----.f4&_-- Total Length _____!;Z4_d.._.__._. 'D' Box ___d7_____ Type Filter Material M&O-60 epth Filter Material ----------C-h ,------------------I...... „ i Distance to nearest: -Well __ _________ Foundationy ---Z �------------- Property Line -_/ZV______-_.__. SEEPAGE PIT J Depth _45----------- Diameter __: g_______- Number -..% - -,--------------- Rock Filled Yes No iC Water Table De th.�"_'`_--____-----$�_______ta_��14k___Rock Size -------------------------------- ' p , Distance to nearest:tWel! __ /__ -________________________Foundation __ ' r-- Prop. Line /� �__._..__.. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ___._____-I_______________________) s Septic Tank (Specify Requirements) -------------------------------------------------------------------------t------------- 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 acc6idance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health bilstirict. 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 beconiSsubjecttp Workman's Compensation laws of California." Signed x. -w« �~�------------ Owner Title B ----------------------------------------------- ------------------------------------------------ (If other than owner) //�� FOR/DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . J ''1le G------------------------------------------------------------- DATE —------------ BUILDING PERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE -------------•-----------•----------------- ADDITIONALCOMMENTS --------------------------------------------------------------------------- -------------- ------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- x --------------------------------------------- -- -- -- Final Inspection by: __.____ _._ Dat - -------------------------------- ------------------------ ----------- - -- gg-- --------- ------------------------------------ --------- ---f'--------._---_._ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M