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u - FOR OFFICE USE- lb ' APPLICATION FOR _SANITATION PERMIT J .r. _SANITATION •___ .__._ _A_ _ �c . ...t Permit No. _ (Complete in Triplicatel ��._____. .___. --------_--------------------------------_____________:_ This Permit Expires 1 Year From Date Issued Date Issued -------------------- Application -T-:- --.71 A lication is hereby made to the Son Joaquin Local Health District for, a pp y � q � � permit to construct and install the work herein described. This application is made in compliance with County drainanoe No. 549 and existing'Rules and Regulations: I J . JOB ADDRESS/LOCATION +�--�--�-- ,� ��'� ----------------� -- - -- --- -----------CENSUS TRACT --------------------------- Owners --------------------------Owners Namei � �� =- -----------------------=--------- --Phone ---------------'------------••---•---- - lv -- Address ' - .�.------------- City _ � _ / ----------------------------------------------- Contractor's -------------------- ------- _ ------------------ - - - -- - _ Contractor's Name .,�erz_�f-r:A67e 1 ___________________________________________License Phone �z Installation will serve: Residence'[] Apartment House Commercial ❑Trailer Court ;❑ - •Motel ❑Other Number of living units:.______ Number of.'bedrooms _______Garbage Grinder ___ Lot Size _ `_ _ - - ----------------------------- Water ___�1� ❑_ ______-___ Water SuPPIY Public SYstem-and-name ---_-:------ Private[ Character'of soil to a depth of 3 feet: Sand"❑ —Si-It Ei' -Clay ❑ Peat❑ Sandy Loam E]: Clay Loam [_] Hardpan ❑ AdobeX Fill Material _ If yes, type _____s,__.__?______________ (Plot plan, showing size�of lot, location of-system -in -relation-to-wells;"builc iAgs, _etc. must be placed on reverse side.) NEW INSTALLATION: (No,septic tank or seepage pit permitted if public sewer is available within 200 feet,j } ] [.] Size--------- ----=-- - - - Liquid Depth .----------....-------_- PACKAGE,TREATMENT SEPTIC TANK' 4 It O ` Capacity - P tY ---- Type -----------:-� - Material----- ------ No. Compartments ---------••---•-•--•-- � . i I Distance_to_nearesf: WelL. - ---- - -- -------------=-Foundation ---------------------- Prop. Line ------•--------------- ULEACHING LINE [ ] No. of Lines ------------------------ Length` ofk each;_line_________________ __________ Total Length __________:___________._:__ I 'D;I,Box ------------ Type Filter Material -------------------Depth Filter Material -------- .-----------------"••-- ,.;.` . .. Distance to nearest: Well ______ "---------___T,F.oundcition ______________________ Property Line __________ . Diameter ..._.._ `•:... SEEPAGE'PIT Depth ___._'_._-_ ; __ .__; DiameterR-_______________ Number. ' __._ ___ ____ Rock Filled Yes E] No,0 k � a Water Table Depth.--------------------l ;. ----------------------------- ' •' Rock Size ----- - . Distance to nearest:',Weli ----------------- .._.-----------Foundation --------------------- Prop. Line I-------------------.- REPAIR/ADDITION{Prev. Sanitation Permit# -----------------------------11 Date ---------------n�_________________} Septic Tank (Specify Requirements) _ ._____.-'__________ ________ _-------------------------------------------------------------- f f : - Disposal Field (Specify Requirements) ✓--------------�- ---X-_/�''_ r ----------------------------- --------------------- -----r7--------� 1 � ,� � ---------Sj ,s - -,---- -� '------ --------------- ------------- ------ % ;103 ' --------------------- (Drawez;sting 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, II shall not employ any person in such manner i as to become subject to Workman's Com ensation laws of California." r I Signed --- -------------- --- ------------/ - - --- ----= --------------------------------- Owner BY -(d- --- ------- ------ - --------------_ • itle . ------------------------------------------------ e --------------------------------------- -- - T ( er than ownerM OR TMENT USE ONLY APPLICATION ACCEPTED,,BY ------ --------------- --- -------- ------. .DATE ---- " '71.------------------- BUILDING PERMIT ISSUED=a. = = --------- -----------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ,-- -- - ------- - --------------- ----------- - --------------------------- - ---------- --- --- ---- ------------------------------------------------------------ -- - - ;Y ., k 'x ► .i k t. Final Inspection b -Date _ SA JOAQUIN LOCAL HEALTH DISTRICT ' E. H. 9 * ,1=68'Re . 5M