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FOR OFFICE USE: ' APPLICATION `FOR SANITATION PERMIT ------------------------------------------------------ (Complete in Triplicate) _ u Permit No: -7-2--7:72-- -- -_ _ _ ___----------.- 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 con truct and install the work herein described. This application is made in compliance with County Ordinance No. 549 zisting Rules and Regulations. ,. tt Y JOB ADDRESS/LOCAT ON -- _/�_-_ 1,3,3 i -3-C-- __� -_ SUS TRACT -S 7--------------- Owner's Name --------------- ------Phone ----- ----------------------------------------- -- -------- o--?- . Address - - -------- ity -- ----- ---- -- Contractar's Name ---------- ---- ------------- ""-- License #.41r _-- Phoned a Installation will serve: Residence Apartmen House❑ Commercial:❑Trailer Court ',❑ Motel ❑Other -------------------------- ------------ -- �7 - f Number of living units:----- Number of bedr oms'-a.i------Gar e Grinder __� _--__ _ � g ��`Lot Size ".- Water Supply: Public System and name --------A"'�" r--- - ----------Private Character of soil to a depth of 3 feet: Sand'D Silt❑ Gay ❑ Peat ❑ Sandy Loam ❑ Clay Loam:❑ Hardpan Adobe ❑A Fill Material ----- ---- If yes,type ---------------------------- (Plot plan, showing size of lot, location of system in elation 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,) i\ PACKAGE,TREATMENT { ] SEPTIC TANK�k Size--" -: - "> .� .............. Liquid Depth __ ------------------ � Capadty�d2dll" .Type Material_-- No. Compartments __ ......... .... W k Distance to nearest. Well -----:�G--_-------------- Foundation "",lQ- --------- Prop. Line -----\S LEACHING LINE {��' No, of Lines -------------- Length of each lirie_�- � ._____" Total Length ."_ - `~ 'D' Box ----/---- Type Filter Material - -----Depth Filter Material -----Z 14?--__ Distance to nearest: Well ------ ` - --__- Foundation ---41-CJ--/----___. Property Line -------S�_" ........ SEEPAGE PIT Depth Diameter, Number -----o2------------------- Rock Filled Yes ( No 0 Water Table Depth ---------9U------------------------ -- ----Rock Size -------t�. ----------- .. .,.. t r / r 4r ti Distance to nearest: Well ------- -- -----------------s-------Foundation -1 ----------- Prop. Line ...--3 ........... . ; t REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------+--- Date ----_---.-----___----___--__._--_-) Septic Tank (Specify Requirements) +, ------------------------_- --_--------------------------------------------------------------------------- Disposal Field (Specify Requirements) ---------------------------: --- -__-_ __-_ t � -------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that (,•.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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------------------------- BY Owner Title --- .., (If other than owner) / ! # FOR DEPARTMENT USE ONLY APPLICATION ,ACCEPTED BY --- -- - -------------------------------- DATE -. - --------------_ BUILDING PERMIT ISSUED -------------------------------- :------------------------------------------------ •--------------DATE ADDITIONALCOMMENTS ------------ ---------------------- - ------------------------------------------------------------------------------------------------------------------------ -----------s----------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- - --------- ---- ------------------------------------------------------------------------------------------------------------------------- ----------'------------------------ = --- --------------------------------------------------------------------------- Final inspection b Date -_. ---- -- --"-" - ----_-"".--- Y' -.. ----- �- SAN JOAQUIN .LOCAL HEALTH DISTRICT. E. H. 9 1-'68 Rev. 5M.