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R�FFICE USE: � _ .F JICATION FOR SANITATION PERMIT Permit No. -�Cf--�� d $ $ j�3 O (Complete in Triplicate} /b - — -., 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 described. This application is ode in compliance wit County Ordinance No. 549 and existing. Rules-aid Regolations: JOB ADDRESS/LOCATION . - ---------e�/---------------=------ ------ -CENSUS TRACT ------------� --- i Owner's Name w - Phone Address ------1----0-`--- -- -------------- r -- ---- - --------- City ' i c -la jt,,, +. i. ` r Contractor's Name ------ -------------- _ --1 -----------------.License'# ------------------`---- Phone r Installation will serve: Residence Ef Apartment House-E] Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- i :. Number of living units ----- Number of bedrooms --- Grinder _" Lot Size --_____--__--_----_----_ --------------- Water Supply: Public System and name ------------- ---- - ---------------.--------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'[] SiI�CI Peat Sand Loam Clay Loam .0 ❑ CI ❑ ❑ Y ❑ Y ❑ Hardpan ❑ Adobe 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r PACKAGE TREATMENT { ] SEPTIC TAMC, ]� Size-------_L?_`1�__.--- _- --- 5-..- Liquid Depth -----�-------- ---. ^ Capacity _I- �D-(�jJ�--._- Type _-- ----its '-- Material--� .No. Compartments -------------- ------- V /Q I Distance to nearest: Well -------�-------------------------Foundation - --____-------------- Prop. Line -S_-f---_-------- LEACHING LINE JI—I— No. of Lines ------ ------------ Length of each Total Length __��................ } T r 'D' Box __---------- Type Filter Material '?0t41--------- Filter, Material ---el------------------------------------ Distance to nearest: Well -- -- ------------- Foundation Foundation ____ ____ Property Line _��----------- ........ PIT (`j- Depth ---2 ---___--__ Diameter -__3_ _-! Number ------- --- --_:' _-- Rock Filled Yes [N Water Table Depth ------------------------------------------------Rock Size --------- to nearest: Well ----------------------------------------Foundation ----- ------ Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------_-------------------------} I Septic Tank (Specify Requirements) ------------------- ---------------------------------------------------,<_--------------------------- DisposalField (Specify Requirements) ----------------------------------------------------------------------------'---- ---- -----------------------------------•----------- (Draw existing and required addition on reverse side) 1 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquln County Ordinances, State Laws, and Rules and Regulations of the San Jpaquin 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 sublegI orkmawy1compeggaticin laws of California." S�9 ` ned ----- - - ---- -- - ----------- --- ---------------------------------------- -- Owner BY ----------------------------------`--------------------------------------------------------------------- Title - ---------- - -- --------- ------------------------------------------- (lf other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ ----------- DATE JQ� �I .............. BUILDING PERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE ------------------------------------- ADDITIONAL COMMENTS ---------_ -- � 61 -- ------------------------------------ c- - --------- -- �lv �--------------- -------Date ----------------- ------------------------------------- ---- - --- ` GFinal Inspection bY '- - SAN JOAQUIN LOCAL HEALTH DISTRICT E.,H. 9 1-'68 Rev. 5M