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FOR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT - - - ----------E�--_------; --.-------------- � Permit No. -.71_ ------__- (Complete in Triplicate) This Permit Expires ] 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 is1 made,ign compliance -with County Ordinance No. 549 and existing Rules and Regulations. ' JOB ADDRESS/LOCATION --1----1--_ v-g---- ,-----� -U ha-«-Q_____ ------..CENSUS TRACT -----�Z- ----------- Owner's Name 1 ----------- Phonej�..Y { =t`�' - -1411 '' - 9' 3F_� �pp yt ! � Address ...h.t-Q1' QX ---------------------------------------------------_ City -1~-/..�j1.4__ r.+....--��----------•----- Contractor's NamePG _ ...License # r�l�l ... Phone _'. . [ ------_- Installation will server Residence ❑Apartment-House❑/Com1mercial ❑Trailer Court ❑ Motel ❑Other1 / - � L Number of living units:---!....._` � Number of bedrooms --- :-..Garbage Grinder ------------ Lot Size . r�X... Ye4 "OX Water Supply: Public'System and name ----------------------------------------------------------------------------------------------------- --------Private ❑ r Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Material ------------ if yes, type .............]-------------- G r (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,) 9/ p; PACKAGE TREATMENT [ } SEPTIC TANK�X Size- --------------------- Liquid Depth ---yv.�---.._.----- Capacity12.00.cal. Type�rG._05-t Material_ No. Compartments __2—-------------- - `S Distance to nearest: Well __..__.�-Q__i_______________Foundation -./.D-----:------ Pro . bine __ ____:________ LEACHING LINE [ No. of Lines ----/------------------ Length of each line-------- ------------- Total L ngth ---- ---- --d-.l_."-- 'D' Box ._..____.--. Type Filter Materials aDepth Filter Material .�._ � -------------------------------- Distance to nearest: Welder Zi D___------ ��ctation d..r........ Property Line. ... �-----.---- SEEPAGE PIT [ ] Depth -------- Diametery--------------- ^Number -------------------- Rock Filled Yes ® No i❑ Water Table Depth ..----Rock Size -_-7 .---------- 3 1+ Distance to nearest: Well ----------------------------------------Foundation ---------------.---- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) � Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------------------t-..-_,------------------------------ Disposal .---------------- ------Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------:---------------------------------- ---- ----- ---- ---------------------------------------------------------------------------- --------- -------------------------------------------•------------------------- ------------------------------------------------------------------ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. klome 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 becomes'/i/ect to Worl �' Co ensation laws of Californian' - Signed u� - Ovrner.' ,r}. 5 s' By ----- = i Title ------[ c -=r If other than owner . ? 1 FORiDEPA-RTMENT USE ONLY t APPLICATION ACCEPTED ..BY`-/ F---- ------ --- ---------- --- --------- BUILDING - -= =DATE"-- ADDITIONAL COMMENTS ff. -��--- - 7 ------ ----------------------------------------- ------------ ------ ------------------------------------------ ---------------------------------1------------------------- - �-s 6 � - ---------------------------- ------------r ----------------f---- j (a j -ollnspecion b - ----------J--------------------- ---------- --- FinDate - SAN JQU1N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -