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FOR OFFICE USE- � APPLICATION FOR SANITATION PERMIT -�d '? Permit No, ------------ -------------f (Complete in Triplicate) - Date issued 3-��- 7v - ------------------ This Permit Expires 1 Year From Date Issued A licribation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desced. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: S..E , Sc., V - -S --CENSUS TRACT JOB ADDRESS/LOCATION ----- Je 0 .---.S"Q -------- -------------- Phone ---__------ Owner's Name ''__ r - � Address _. _ � e l�`,l ------', --------------------- ----•--- City _ / --------------------------------- G ------- Z --------License #`- % --- Phone.lt � � Contractor's Name j��- -••--—5-47--77 E Installation will serve: ResidencetR] Apartment House❑ Commercial :❑Trailer Court l❑ ( Motel ❑ Other ------------------------- �7 ----6 - Lot Size =- --6:k--�0---- Number of living units:-__/--_._- Number of bedrooms _-' -____Garbo e Grinder -.tv c�. 9 � Private ❑ - ---------------- ----------------- Water Supply: Public System grid name ------------------ --- --------------- --- --- -------------------------------------------------------------- -----""- - " - - Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay i Loam.E] Hardpan ❑ Adobe,0 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.l NEW INSTALLATION: (No septic tank or seepage pit permitted-if public sewer is available within 200 feet,) - Size__ ___ __ -�_ �`l/-- - ------- -- Liquid De t}t -�----- ------------•-- I PACKAGE TREATMENT [ ] SEPTIC TANK - " No. Com artments _• r = 00G4Type - Material- � p q .01 t ---------- 'Capacity ' Distance,_to nearest:.Well ._____-�C�_�-'------------------Foundation -_�-°----------- - Prop. Line -S-_-_------•----•-- N IFINNo. of Lines l Length of each line-__-lad------- ------ Total LengthQ-1J-�--------- LEACHING LINE [A- ------ ------- - if 'D' Box, _=_.-- Type Filter Material _ --- Depth Filter Material -Al--------------------- b ------ ------ Foundation -----1 1----------- Property Line _5---------- -a s Distance to nearest: Well SEEPAGE PIT � Depth _ --5_--- ----- Diameter -- - ------ Number ---------- ----- ------ Rock Filled Yes ` __.Rock Size __--- k Water Table Depth ------------ -•----- �l�--- -- ---------- Distance to nearest: Well ---------1-6VU l----------------Foundation _ ------ Prop. Line _.--- ----------- ` ---------1 • ------ ------- Date ------------------------- REPAIR/ADDITION(Prev. Sanitation Permit# _________------------------ Septic Tank (Specify Requirements)�-..----- ------------------------- i k tr: Disposal Field (Specify Requirements) - -------------- ,.: ----------- ---------------------------------------- --- ----------------------- ----- -------------=-------------- ---- ------------------------- -------------------------------------------------------------------------- (Draw existing and required addition on reverse si d e 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 pe emit is issued, I shah not employ any person in such manner as to becom/su ject,to orkm n s Compensation laws of California." Owner - Signed ...... ----------------------------------------------- --------------------------------- ------------------ Title ----- --------- ------- (if other than owner) FOR .DEPARTMENT USE ONLY } DATE 3 ��-------- APPLICATION ACCEPTED BY'-e"I - BUILDING PERMIT ISSUED ___-- ----- -----"" """""--- - --�---- --DATE ------------------------------------------- BUILDING ------------•-�---�----- -------- ------- ADDITIONAL COMMENTS -------------------- -- -------------- ---- -------- - - - --- --------- ------------------------------------------------------------------- ------------ ------------ --------- -- -------------- ---------- ----- --------- ------------------------------- ------ - -----�- Date _. _ --� - 1 Final Inspection b --- -- --=------ SAN J AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M.