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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------=---- (Complete in Triplicate) Permi# No: --------- --------------------------------- _�_-'_1. " � --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued 3.� Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made incompliance with County Ordinance No. 549 and existing Rules and Regulations: t 7M JOB ADDRESS/LOCATION - - __--- - 19-----CENSUS TRACT Owner's Name �`-�7-�- .� 'L>G'fS----.- .N7 T �,/ - Phone - ----- Address ---6aI�/--2". f�1if0"------------------------------- ------------ City _� 4. �t.[��SC� f =--•------ Contractor's Name _____ L� ei.1 .---------.License # ,:- �- - _ Phone __ �'.rT - Installation will serve: Residence ❑ Apartment House,[] Commercial ❑Trailer Court i❑ Motel ❑ Other C �J� 1 Number of living units_____________ Number of bedrooms --___c__;_-__�_Garbage Grinder ------------ Lot Size �crJ,�-_____________..___ Water Supply: Public System and name ----�---_�'" ______Private w --.2�_amara._iC'�.----------------------------- - - --- ------------- ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Pea Sandy Loam Clay Loam:❑ Hardpan ❑ Adobe ❑ Fill Material -----------. If yes, type ------.____________________ (Plbt-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,) PACKAGE TREATMENT [ ] SEPTIC TAN K;[], .,..,- Size---.* -.1 _______________ Liquid Depth __��----------______-- Capacity _12,00 Type ------------- -____ Material- a/ces No. Compartments ___�_____--..._-• 4 Distance to nearest: Well ------.x�__a___P-_______________ p -Foundation __/Q__._________ Pro Line ___:________ � LEACHING LINE No. of Lines �- [ ] .f1�fA5_ Length of each line._._,Z,�______________ Total Length _Z_4P_Y ---- 'D' Box Type Filter Material `- YP ----¢'---f�Cl�_-Depth Filter Material __�`�r--------------------------------•- 4—.__ s Distance to nearest: Well ___�?` ------ ------ Foundation ._�Q_ _ _________ Property Line SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number .-_----- --;---_____.______ Rock Filled Yes ❑ No I Water Table Depth ------------------------------------------------Rock Size -------- ----------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _____-_-__--__.___--_. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------__-_-__) SepticTank (Specify Requirements) -------------------------------------------------------------------------------------------------- --•--------- --------•--•--•------- Disposal Field (Specify Requirements) ----------- -•---------------------------- -------------------------------------------------------------- ! ---- ----------------------------------------------------------------------------------------- t (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin j 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 permit is issued, I shall not employ any person in such manner as to becombject to Workma Compensation laws of California." Ar Signed ----- -- - - --- ------ ------�-;-'{-�--r--------------- Owner By -------------------------------- Title ------------------------------------------------- {I ther thdn owner[ F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- DATE __ /. -.7 ---------- BUILDING PERMIT ISSUED --- ------------- --------- DATE ------------------------------------------- ADDITIONALCOMMENTS --------------------------------------------------------------------- ------------------------------------------------ ---------- ------ ------------------------- ----- -- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- - - - -------------------- -- ----------------- ------- ----- -------------------------------------------- Final Inspection by: ------- --- --- -------.Date --- -------- SA JOAQUIN LOCAL HEALTH DISTRICT E_ H_ 9 1.'68 Rev_ 5M