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FOR OFFICE USE: a /eS-9 APPLICATION FOR SANITATION PERMIT ...... --------------- ------------------ 7 3-.-s 6-0 : ._ _ iCompiete in Triplicate} Permit No ---------------------- . This Permit Expires 1 Year From Date Issued Date Issued • h 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 made in compliance with Count rdinance No. 549 a ex stenq Rules and Re lat' in �jj,-�. ffJ��p sT20'Q� Y►�/" ?d^-° �'� 8�-� �-a 2� : C�- '$�.3 -� � � JOB ADDRESS/LOCATION - --- ---- -- - -- -------- --'__-- � - - -- --------- -----..CENSUS TRACT -------------------------- 5 Owner's Name -----A__v --------- -------------------------------------------------------------------- ------------------Phone 0 Address ------- �9� f , 74�4 -�----- - -------- -- -------------- ----=-------• City - -- - -- -------------- Contractor's Name _ .-- / - =------------- ----------------.license # Phone Installation will serve: Residence Apart ent se m el rcia ❑T iter Court ;❑ Mote! ther _________d /_C^__ _ ___�' -- �17Z '01 1" Number of living units:___!_____ Number of bedrooms --___Garbage Grinder __________ Lot Size - _____________________ Water Supply: Public System and name -------------- � T- P_ ' Character of soil to a depth of 3 feet: Sand'E] Silt.E] • ,Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,0 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,) PACKAGE TREATMENT [ ] SEPTICTANK)< Size_____9'1%__,,'5_`X_5_T_:_---------- Liquid Depth -- � Capacity _k1 Type ,o(_-_ Material_ _ _ o. Compartments --�____-:--_. Distance to nearest: Well -- �. Foundation _/Q_____________ Prop. Line ___�_____________ LEACHING LINE [ ] No. of Lines ------'i---------------- Length "of-each line' a0--- ----- Total Length ------------ 'D' Box ._A).0__ Type Filter Material _�-_�________-Depth Filter Material _._ ---______-- ---------------------- Distance to nearest: Well ___150-- ______ Foundation ___________ Property Line - f_____________ SEEPAGE PIT [ ] Depth ---c*-J-------- Diameter �-_______________ Rock Filled YesK No i❑ __�_��_____ Number .___._ QQ / u Water Table Depth -- •-------------------------- -------Rock Size _ _ - ----------- Wei 452. / / Distance to nearest: Well _____/,v�_______________________Foundation __ �__.____-._ Prop. Line �--------- -.-- I REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ____.-___-_---..----__--_____.____) SepticTank {Specify Requirements) ---------------------------------------------------------------------------------------------:----------------•---------------------------. Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------ ------------ ----------------------------------------------------- - ------------------------:-=---------- -- ------------------------------------------------------------------------ r,r (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. 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 subject to Workman's Compensation laws of California." Signed ---------- -------------------------------------- Owner y U Title ------------------------------------------ Y ----------------- -- ther th owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- _ __. DATE __:.^I.3_"_�_3--------_______ ---------------------------------------- BUILDING PERMIT ISSUED --------------- -----_-DATE --------_---------------------------------- ADDITIONALCOMMENTS ------------------------------- ---------------------------- -----=--------------- ------ ------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- ----------- ------------------------------------ -- - --- ----------------------- ----------------------------------- - --- - ------------------ Final Inspection by: --- ---.Date rf - `3 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M