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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - 7� ------------------ ---------------------------=; Y (Complete in Triplicate) q G --------i-------------------y-- Date Issued This Permit Expires 1 Year From Date Issued l�to the San Joaquin Local Health District for a permit to construct and install the-work-herein Application is hereby made described. This applicat;on is made in compliance with County Ordinance No. 549 and existing Rules Regulations: I ----------- ------ ------CENSUS TRACT ------------------ _W JOB ADDRESS/LOCATION _I- �o �� l Phone - ... '- Owner's Name ------ - 5f Address ------;-- ��--�;--t- _ - Contractor s Name -___--_ ` License #Ijkf� Phone ------------------•------ Installation will serve: Residence ApartmentHouse-ig.Commercia�OTailer C2urt i❑ .Address r • 4 / License No, 2�1�2 Phone Contract C� _ Private [`j nd' I l ' - - - Water Supply: Public System and name ---------------------------------� �- % Clay Loam:❑ Character of soil to a depth 3 feet: Sa ❑ Clay ❑ Peat ] Sandy Loam ❑ Y a p � . Fill Mat jre alA:---------:__(f,yes, type ------------------------------ -1 ----- ----------- - -- -- __ Hardpan Adobe ❑...,.._'. . _. _ 1 _� - {Prat plan, showing size of lot, location of system in relation to wells, buildings, etc. must_be'placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitt€d`if-pubiic sewer-is_availab a within 200 feet,) 1� Liquid Depth -------------- PACKAGE TREATMENT [ ]� SEPtICTANK,[ ] I Size--------- ,--'--- ---- q p \ - Material---------------------- No. Compartments --- -------------- 7- Ca ----------- :A>j ----- ,P6 ;� Distance to nearest: We11 '- ----------------------founda'tion ---------------------- Prop. Line ------•----------• I t Total Length ----- -- : Length of each line------------ ---- g LEACHING LINE [ ] No. of Lines Type ,. D.' Box ------ ----- T e"Filter Material ------Depth •Filter Material -----=--------------------- ---------•------ ' f Property Line ------ Foundation p rtY ----------------------- Y ---------------------- I 7� Distance to nearest: Wel[ �_________ -- _ ----------------- ---- i _____ Rock Filled Yes`❑`� "No i❑ EEPAGE PIT [ ] Depth - ---------------- water -- - -- Diameter Number Water Table Depth -------- ------- Rock Size -------- ---------------- ----- # �� Foundation = -j Prop. Lige --------------------•- # Distance to nearest: Well ____--___!______________ _ I - ---------- Date -----=----------t------------- (,.REPAIR/ADDITION(Prev. Snitation Permit# ---------=- IM Se tic Tank (Specify Re( uirements] --------------------------------- ---- -i--- ) , i I� ---- �------------- -------------------- Disposal Field (Specify. Re uirements) i ... r �'•J _r___ -;------------`--`-----------•-------.. w _ - - '{ ' 1 .. -------------�----------------------------------- - - - --------------------- ------`- -"- (Draw existing and ------------------------- -- --------------------- - g required addition on reverse side) ] . ,' 1 hereby certify that I haue.prepared this�applicption arid- that the work will be done in accordance with�San .loaquie """' County Ordinances, State��Laws,.and'Rules and Re' t lu� Mons of the San Joaquin Local Health District. Home owner ar°lice - I sedagents signature certifies the following: "I rmance of the work-for which this permit is issued, I shall not employ any person in such manner certify that in the perto as io beco t to man's Compensation laws of California." Signed I -------- -- Owner -- ----- - - --- --- -- ----- - - -------------------- Title ---- f By - ---- ---- (if other thakn ner) III FOR .DEPARTMENT USE ONLY [[�� APPLICATION ACCEPTED�� BY --- - -- -- --------- - =--------------------------------- DATE t: <•---•---•----------- BUILDING PERMIT ISSUED ---------------------- ------------------------- ADDITIONALCOMMENTS ----------------------------------- ---------------------------------------------------== ii------------------------------------------------------------------------------------------------------- I ------------------------------------------------------ ------------------------------- ,I. ---------------- ----------------------- ---------------------------- Date 4 ------•-- -- Final Inspection by. - - -- - --------------- -- �- . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.