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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------ 'Coni late in Tri licate} Permit No. _.-7l-3-�Sr P P ------ --------------------- - ------------------- This Permit'Expires 1 Year From Dade Issued Date Issued ---`- ' Application is hereby made to the San Joaquin Local Health District for a permit to constructsand install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION «---- �v--------- _ ENSUS TRACT Owner's Name ,(- --- ---/`d_ �r' ------------------------------------------------------------ Ph n Address _ 4 -------------------------- /t -- - 0--- --- --------- City ---------------------------"s" ` „ Contractor's Name ._-- ------ - -��- ” _ ------ Phone -_------ --- •-• Installation will serve: ' ResidenceA Apartment House❑ Commercial ❑Tra.iler Court. ❑ Motel ❑Other = -- f f bage Grinder /�f _-._ Lot Size .............. Number of living units: Number of bedrooms� � g Water Supply: Public System and name --------.t __ ___._____Gar - - ---- --------Private Character of soil to a depth of 3 feet: Sand❑ Silty Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ Hardpan ❑ Adobe Fill Material -----___-""- If yes, type ""____._____-""__ fl� (Plot plan, showing size of lot, Location of:system in relation to wells, building's, etc. ,must be placed on reverse side.) NEW INSTALLATION: (No�septic,tank or seepage pit permitted if public sewer is available within 200 feet,) t+w ;PACKAGE TREATMENT SEPTIC TANKSize_ ZZ-f- ------ Liquid Depth .T1,;.--- Iy Capacity/142 .---- T0 "r„�_ Material f _` _-- .No: Compartments -" , , 4Distance f#•nearest: Well ___""Foundation . _: ____"___ _ Pro Line _ - -- p• .: �, 4_11 LEACHING [INE No. of Lines ____�_._ __...___ _, �- - � Len th of each lineD,�� Filter Mctterralal Length 1 --- -----_ _ g , � � 'D' Box ,�/ � ' / lYe-- Type Filter Mdtena � p /?/l , -------- Distance to nearest: Well _ ___P__:__--__ Foundation - _ --fQ- ."---------- Property -Line SEEPAGE PIT PIT [ j Depth ) / X r. Diameter ,fC�,(--_ Number __ f __ Rock Filled Yes,< No i❑ —� 00 Water Table Depth ___-__ ___ _ Rock Siz -------------- °- IDistance to nearlest: Well _.401"o -----------------------------Foundation ------------- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date --------------:--------------"""_-) Septic Tank (Specify Requirements)1 0 ______________________ - = Disposal Field (Specify Requirements) ---___________-_ } ----------------------------- ----- --- ----------- ------------- _ --------------`r -'------ __ __ _ • i _. �.• q. (Draw existing and required addition on reverse side) � I hereby,certifythat J' have prepared this application and that the work w .. ll be done,in accordance with San Joaquin County Orb inancesState Laws, and Rules and Regulai tions of the San Joaquin Local Health District. Home owner or Licen- sed agents signature certifies the following: 4 ' "I certify that;in toe pe4ormance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's "Compensation.laws of California." Signed ---------------- -- -------------------------------------------- Owner BY .. --- -A J 1. Title ' .• ther than owner} r ---------- FOR .D AiiTMENT LISE ONLY APPLICATION ACCEPTED BY 3 DATE R � BUILDING PERMIT ISSUED _',_.___.____"�_____.._____ "- QATE _. -------- 1TIONAL COMMENTS -- ------------�--------- -- --- ------------.. -----------------------------------•--- 1-------- r ---- -------------------------------- - - , _________________ 1, - _.______ ________.________________ _____________ - _____________ ------------------------------ 4. Final Inspection liy: --------- ---- ----------- r ---- ---------------------- -- - -- ---- - `---- � t ------Date ------- SAN -----SAN JOAOUIN LOCAL HEALTH DISTRICT E. H. 9 T-'68 Rev. 5M {,