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FOR OFFICE USE: aIC.� _ _ APPLICATION-fOR SANITATION PERMIT _ ------ C�-------- ------- �� Permit No. 6 q_- 'y_2_a .�. (�nomplete in Triplicate) Date Issued --------------- ---- --------------------7------------- This Permit Expiresµ1 Year From Date Issued 4S'6-02®�-t/ 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 made in compliance with, .,QDg4v„ Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ------- 2s. ,'---- l//G nig 15�----- - r` s- --------------CENSUS TRACT - '- -- --.--- Owner's Name ---------------------------------------------------------Phone -9;131 Address ------------ Jur 6 --. City ----------------------------------- -•----------- Contractor's Name -----5&5/19�----------------- ----------- ----------------------- ---------.License # ------ --..^r- Phone ---------------------•-_--- Installation will serve- Residence ❑Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ------------------------ ------------------- Number of living units:---I------- Number of edrooms _______Garbage Grinder W--- Lot Size _L7L��_� -_-________ Water Supply: Public System and name -- ----------------------------------------------------- Character Private 0� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam In Clay Loam ❑ Hardpan ❑ Adobe g4iII 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,) t]o PACKAGE TREATMENT f ] SEPTIC TANK Y ZS e`__._ l x CJ-X. ?•�_-_--____ Liquid Depth _-- ----- ,aW Capacity __ 100____ Type MaterialNo. Compartments ._ _______________ �♦ ' Distance to nearest: Well ___ __ _______________________Foundation ___1�____________ Prop. Line __I _______..... LEACHING LINE (LJ'_ No. of Lines ___-_____________ Length of each line___eQe--------------- Total Length ----2- V -------- 'D' Box SRA.__ Type Filter Materialepth Filter Material ______A7 ___________________________ v -Zg�--------- Property Line ----------- Distance to nearest: Well ___�"�_ __________ Foundation ---- SEEPAGE PIT f ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation --------------- ---- Prop. Line -------.__.._:.__...__ REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- -- Date ----------------------.-----------1 Septic Tank (Specify Requirements) -------- ------- -- ----------------------------- -------------------------------------------------------- Disposal Field (Specify Requirements) ___________________________ _ __ ------------------------------------- -' "7 --------- - --- -- -- - - --- - -- - -- -------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 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 performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to bec me subject to Workman's Compensation laws of California.” Signed ----- -:--------- ---------------------------010'w n e r ,/-- Title ----------------------------------------------------------------------- (If other than owner) FOR DEPARTENT USE ONLY APPLICATION ACCEPTED BY ......... r -- ----- ----------------------------------------------------• DATE ------ ^�3_.`_9,i_ :------- BUILDING PERMIT ISSUED ------ ---- -------- - -- --- V ----DATE ------------------------------ ------ ADDITIONAL COMMENTS = _ _ - -` .----- = _ = ` ----------------------------------------------- ------- -- -------------------------------- _4 ---------- --- ------------- - --------------- ------------ - - ------------------------ ------ Final Inspection by. C� -��.� ----------------------------------------------- ------------------Date --- �i - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M