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FOR OFFICE USE: ° APPLICATION FOR SAN1-1 4ITATION PERMIT ' {Complete in Triplicate} Permit No: y�_ �5, ='---_ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District fora # described, This appiication is made in compliance with County Ordinance permit and existing Rules instalnd-Regu�'lat o the work herein JOB ADDRESS/LOCATION II- - _--- r -- ___CENSUSCT:RACT _---Owner's Name 6p Zr�-IF----------- a- � ----- - Phone -------- Address 7_71-f-, -- Cite" --- --------------------------------•----•-----------•----•--- Contractor's Name ,.�-------------------------- ------ ----_- License # ---------------- ------- Phone _.------------ Installation will serve: i, Residence- b Apartment House�i� C�qmrr, ;�,�,n,1wiw r.,,,,. . _ WELL CHLORINATION LJ WELL ABANIJUNMt U i ncra• REPLACEMENTO di t �r1 Pit Privy nic-rnni!^C Tr) I�IFAGFC7 Cantir,TAnk__.f.•••U fewer Lines ... - i .,.,�., ------ rpag urmaer !-`-'----- -- Lot Sze --- -- ---- � Water Supply: Public System and name -.- ----------- Private, Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ) Clay Loam -- a Hardpan ❑ Adobe ❑ Fill Material ---------_-- If Yes, type ____________________________ (Plot plan, showing size ofilot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No .:septic flank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ['] I; SEPTIC TANK Size--� '_ -j�_'f'---P v_, ,/ v - Liquid Depth -.y--- ---------- Capacity _ 6-0___-- Type ---- Material---------------------- No. Compartments~A-'__-.------ Distance to nearest: Well --'O---___,--_----- -- - -------Foundation _-3 ___-----_- Prop. Line _4 - Q - LEACHING LINE ] No. .of lines ___ -_ -__-_ --___ Length of each line---___Z�ld_- _3� - --- - Total Length 'D' 6ox4r«s%4Type Filter Material A-&----------Depth Filter Material -_fPf------ ` Distance to nearest: Well - ____fa___-- Foundation - a-' '� ' v --------------- Property Line -r---------- SEEPAGE PIT [ ] Depth � ---__ Diameter o 3.. --------------- Rock Filled Yes ] No 0 Number Watelr a le e h -------- ck Siz ---- ------------------ Distance to est: Well -- --t____--___•,--- ---Fou , ,1 --- a----#----- Prop. ..---•--•---------- PAIR ADDITION(Prev. Sanitation Permit# --------------- __ date ------- Septic Tank (Specify Requirements) _---.__-.- Disposal Field (Specify Repuirements) ------------- , -------- ----------------- ------------------------------------------------------------------------------ ------------------------------------------------- - (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that •the wjrk will be done in accordance with=•San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son 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 Work g man's Compensation laws of California." Signed ._. �,/ 1 �1� ems/- ------ Owner BY --- ---------------- Title --- (If other than ovvnerl FOR DEPARTMENT USE ONLY BUI D NGI�ERMIT ISSUED --- _ ��N ACCEPTED BY . . . - ---------- ---------- ----------- - ---------- ---------- ------ DATE e?7�A_� -------------------- -------------------- - ADDITIONAL COMMENTS ---�'- �- ---.� 7`_-="'ms-µ-----�-_•<�-=-'-----_,.- - �� D -- - ----------------------r----- ---- P �' li ..f ' -— ------------------------------------ -------------------------------------------------------------------------------------------------------------------------------- -- -- ---- ---------------- Final Inspection by: - --- -- -----------------Date _'7 ---- ----------------- ---- - i . SAN JOAQUIN LOCAL HEALTH DISTRICT ` E. H. 9 1-'68 Rev. 5M