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1 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / -------------------- --------------• ---- --- ----- -- (Complete in Triplicate] Permit No. 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 construct and install the work herein descrj,kaed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: Ir. . JO ADDRESS/LOCATION ...4!_ _ -O Z.---5WTi4Sv} --A I-- . _-------CENSUS TRACT -----------6------------- Owner's Name2 3� ►u�-4M;' ----------------------------------------------------------------- ------Phone------------------------------------- J-L2.037- ----------------------------------- Address --�-------------- -2---- ---- _ ----------------- City :EZ.-C-A-L-80J------------------------------------------------ Contractor's Name ._ ... -- p 1S - --- ------ M �C3� ;. Installation will serve: Residence VrApartment House�❑ Commercial :OTrailer Court ;❑ Motel ❑ Other ----------------------------------- -------- Number of living units:--------- Number of bedrooms ------_Garbage Grinder -N -_. Lot Size ---_--------------- Water Supply: Public System and name ---------------------------------•----------------------------------- -----------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ ClayX Peat ❑ Sandy Loam -❑ Clay Loam ❑ j Hardpan ❑ Adobe-E] 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.) V NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,J2�� ! I it - PACKAGE TREATMENT I ] SEPTIC TANK Size54--x.=13' 6g--•------__-_-- Liquid Depth ---------------- ---------- Capacity 12W-&A Type11?fLC&44%T Material-�� No. Compartments �z--_ uA�E (,J est: Well -----5Z)-----------------------Foundation A0---------------.Prop. Line ----�Q---- ---- LEACHING LINE No of Lines nearest: Well Length of each line... ----------------- Total Length __ __._----__..__..- f so 'D' Box -------- --. Type Filter Materia l'-RwS --.__.Depth Filter Material ---uc5---------------------..... ........ Distance to nearest: -------------- "_---- Foundation -._-------_- Property Line SEEPAGE PIT [ ] Depth -------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes -'❑ No i❑ WaterTable Depth -----------------------`-------------------------Rock Size ------------------------------- I Distance to nearest: Well --------------- ------ Foundation ------ ------------- Prop. Line---__-•.----------•-_--- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------~----------------- Date --------------------------- Septic ------------.Septic Tank (Specify Requirements) - U - -.--------- _ Disposal Field (Specify Requirements, -- --- —r-le,----SY*TE.--- '..... --R r --- ' ------------------------------------------------ (Draw existing and required ad ' dition on reverse side) 1 hereby certify that 1 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 --- --------------------- ------------ -------- ------ Owner A - ! a� TitIe. "1_f-4 ------------------------ ------ BY (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----1--LT-A-�- - ----------------- --- ------------------------------------ ---- DATE ... ~/ -C1 1 BUILDING PERMIT ISSUED ----------------- '------- ---------------------------------------------------DATE -------------------- --------------- ADDITIONALCOMMENTS ------ ----------------------=------- -------------- ----------------------------------------------- -------------------- ------ ----- ------ - ---------- ---- - - - ---- ------ - --------------- -------------------------- O -- Final InspectsF� = ------------------------------------------------ ..Date ------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H: 9 1-'68 Rev. 5M