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FOR OFFICE USE:--- "'"� � FOR OFFICE USE: APPLICATION-FOR.SANITATION PERMIT --------------------=------------------------- - . -iCampfete in Triplicate) Permit No. ---------- ----------- -------------------------- .: Date Issued_______________ -----_------------_--------------------------------._ This Permit Expires1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit,to construct acid install the work herein described. This application is made in compliance with County Ordinance No._5A,9 andexis ng Rules and Regulations: ' _ I -- 11 20 JOB ADDRESS/L��OCAgqTION_ . , SO.�_-_Q_S'_._ ._ .�k_ _CENSUS TRACL _-________________t__._. Owner's Name.u.Jf3_� ``-t? �:E'1= Phone Address------------------------- --------------- ----Zi Contractor's Name � ,,. __+4tLVE,-License #__ :T�J_.Phone.Ale��1�R-0 __.. Installation,will serve: Residerice,K Apartment House' C1 Commercial ❑ Trailer,Court ❑ Mot r r ---------- Number,of.:Iiving units----.__-----�: '_Number of'bedrooms _.__Garbage Grinder_............Lot Size____ f'f]C2aE S__ ___,________._.___ Water Supply: Public System and name_r..""' a - ---- ----------------- ------ -------- ---Private El Character of soil to-a depth of 3'feet:, 1 Sdnd ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan F Adobe ❑ Fill Material......... ...If yes, type------------------ (Plot plan,•showing size of lot, location of system in relationj'o-,wells�buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No;septic tank' or seepage pit permitted if ublic sewer is avdilablerw.ithin 200 feet,) o .. PACKAGE TREATMENT" ('] SEPTIC TANK Size __________________.____-________Liquid Depth__� _.___________ i '� ....}.}... C _ a�l _ ___No. Compartmea ts___._ � Distance to nearest: Well -------- ---------- ___ _ _ SOType - . ta __Mter• el-Prop. `-"LEACHING : _ LINE" >( No, of Line ._ __:..Length of ea line_.�^� ______________Tofial L``gth ____________:_______,__ D' Box_/_.______Type Filter Materia�_ l Depth FilterMaterial___! ___.__ ___rndation_.2` --------- ---Pro er Line._____ _� _`1F .Distpn�to nearest: Well__��_=- Number_-_�_____________ _______ � p Rock Filled Yes No �•r' SEEPAGE PIT Y Depth_ . _ _._._.Diameter_: , f Water Table Depth.___`8_�`�f 77 --------------- ----------- Rock Size �j�---------- i 7 i m 'f Distance.to nearest: Well_ _ �_____________ ____________Foundation___ _Q__`� ----..Prop. Line_____________ ' f v ce REPAIR/ADDITION (Prev. Sanitation•Permit#--------------------------------.------____--__-k irDate------------------__.______.___._______.______) ---- Septic Tank (Specify Requirements)-----t � � f Disposal Field (Specify Requirements)______________________ ________ a '� ------ ------- --------------------------------------------------------------- ------------.---------------------------- . -- .--- ---------------------- .::,]---------------- ---------- __�_k�_ ____________-=------- - ---- ------ ----------- --------- ----------- _ _ -Y-�- --- (Draw existing and required addition en reverse side) ti I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co ;I Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agi . signature certifies the following: : "f certify that in the perforniance'of`the work for which this permit is issued, I shall not employ any person in such mann - --- ' � . - �� sof California." to beecdo a su ect�to rkm s. Co nsation i w ` 1Jlat /f By- 1 --- N- Title :�.r'a {If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY'. --------- ---- - - DATE. C� .� 7 DIVISIONOF LAND NUMBER.-- --- --- ------------ ---------------------_--------------------------------- DATE------------- ----- ------ ADDITIONALCOMMENTS----------------- ---------------------------------------=------------------------------------------------ -------- ----------------------------_--- -- �q / .} -------------- ----- --- - Final Inspection by:------_,__.._ G� -------------------------------------Date_.. / X._U:c/?'�---- ---------. EH 1324 SAN JOA UIN LOCAL HEALTH DISTRICT F&5 21b77 REV. 7/7ti 3M