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FOR OFFICE USE: G -- APPLICADON FOR SANITATION PERMIT Permit No. -- -/------- -- --- # (Complete in Triplicate) ---------------------------------------------- Date Issued ------------------------------ This'Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to const ct d install the work herein described. This. a,p-plication is made in compliance with County Ordinance No. 549 and sti les and Regulations: l .l{_ Mt}�,, S4Uj1{ '�F KLII WLj_---CENSUS TRACT -------------- ------- JOB ADDRESS/LOCATION .-�.�t+�-4}��: -- ;� - Owner's Name �`A Gle, s._K" -------------- --------------------------------------------•-------------------Phone _S6ZA59--------------- i . i' Address 53y�D1'ei" ez�, ---. Cit Y Contractor's Name --------Sergi------ ::-------.License # -`� -------- Phone ------------------------------------------------- --- Installation will serve: Residence>("Apartment House❑ Commercial ❑Trailer Court ;❑ 4 �-L--motel—R,Other -------- Number of living units:___Number of bed ooms arba a Grinde'rN� Lot Size __ -_'�`________________________________ i vr.� �_ . _._ �?�y .._—.- -- lf� Private [ =--,- r Water Supply:.Public5ystem_and name=N�___ �'--------------=- --------- ------------•----------------•---------- -- - Character of soil to a depth'of_3..feet.. -Sandi❑.a.. Silt-Cl.,,,,�Clay-.❑,:...Peat❑! Sandy Loam Clay Loam ❑ Hardpan �" Adobe,0 Fill Materia"hN:Q�' If yes, type _--- -------------- ---- i 4 f '� (Plot plan, showi6gµsize--of-.lot;--location_of system.in-relation-to-wells.hbuiIding s, etc. must be placed on reverse side.) NEW INSTALLATION: (No septi tank or seepage pit permitted'' 11if Dublic sewer is vat able within 200 feet,) J r/ ' PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size_-- -_��--_Q__xs--`�'----------- Liquid Depth _�----------------.----- h Type -------------------- Material t��!:g- ----- .No. Compartments _.------- Capacity --•-----:__-- ,rte � Distance to nearest- Well _�_�~_�___----------_--------!.-.-Foundation ---1-�r_____----------.Prop. Line ___� ______ ------ �,,1 0 �If LEACHING LINE [ ] No. of Lines _�___-------------- Length of each line------ Total Length __ _!--____..-_______-__ D' Box -__ ___ Type Filter Material SeVP :Depth Filter Material ...1q_____________________________________ + 1 �S/ _ .r _ J Property Line __ ---------- --------------------- ' Distance to nearest: Wellr# ___ FoUndation�'`"__-_._._--_-_-___ I SEEPAGE PIT [ ] Depth -------------- ---- Diameter ------- Number -------------------------.-- Rock Filled Yes © No i Water Table Depth ----- ------`---------•--------------=--------Rock Size ------ ------------------- .---- p i # Distance to nearest: Well F_____�________________ ..Foundation -------------------- Prop. Line _____.__.__.....__--:- REPAIR/ADDITION(Prev. Sanitation Permit -':----------------•------------ Date -------------------.-----.--------) Septic Tank (Specify Requirements) ------------------ ------ - --------------------------------------------------:---------------------------------- ---------- Disposal Field (Specify Requirements) -------------- ------------------------------------------------------- --- -- ---------------------------------- _- __ - - - ---- - i --------------------------- -------------------------------------------------------- ----------- (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 chat in the performance of the r for which this permit is issued, I shall not employ any person in such manner as to bec a ct Wo Co ation laws of California." Signed ------- - - - ` Owner Y - ---------------- Title ----------------------------------------------------------- ---- ------ (If other than owner) . : 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY '------------------------1 V----- --- ----------- ----------------------------- DATE --- BL1I L-DI G-wPtRMIT-IS5llED ------"--------- -------- ----- ---------- -- - - - - ADDITIONALCOMMENTS -------- ------------------ -----------/----------------------------------------------------------------------------------=-----------.--------------- i ----- t r - - -------------------------------------- � - 'r- . __DateFinal Inspection SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ]