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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- N�- -. Permit No.. (Complete in Triplicate) 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION ._q_ _ �?_ .7 -----------------------------------------CENSUS TRACT .......................... Owner's Name -----/�� i �$,i - hone r --- ---- Address 'C;?Z&--7-----------k �`�'/' 1�� ------.. °-----. City i --------------------------------- _ _ / v a� ------------------- License #, f _ Qhone• � k Contractor's Name ._ __ __ !___. Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ;[] i f Motel ❑Other -------------------------------------------- g _Garbage Grinder __ Lot Size .. �}C_ , , -- --. Number of living units:_._/�_.__ Number of bedrooms ---�._ ••--.- � Water Supply: Public System and name i/-----f�� ` -----------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'7] Silt❑ Clay/❑ Peat ❑ Sandy Loam '❑ Clay Loam.❑ Hardpan ❑ Adobe Fill Material ------------ If yes, type ------------____-_-___--- (Phot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (v,A NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) `N f �jro 0 PACKAGE:TREATMENT [ ] SEPTICTANK; f _ Size-� _J _.._ lf___--__.--- Liquid Depth- ._.__._.._,____. _-T _ �_ Capa ty 2V-Z7--- Type/�� .-- Material.-�(�f��--' No. Compartments -!97:n_'.....:-.-- 4 Distance to nearest: Wel? ___ '...---`-_--_--____Foundation -/4? Prop. Line - ------------ LEACHING --_. _._01 LEACHING LINE 4 No. of Lines ----.-;2-------------- Lenbth of each `line_. 't,J�'-_._ Total Length l". ,P---------------- 'D' `----. _ -.Q' Box - _!��_ Type Filter Material ._ Depth Filter Material ' -------------'�-`--- -_-_ I L 7 Distant to nearest: Well ----- -_`-"''-`------_ Foundation -----.---- Property Line ..... SEEPAGE PIT Depth, -------- Diameter r. ------ Number ----�---_.-,`.f--- Rock Filled Yeses No C) Rock Size - >> Water Table Depth _..._ �__ ...,,..-- " � !' f i -------------Foundation ____ ._ _.---.--_ Pro Distance to nearest: Well ._. ----- p. Line _'�________________ Y REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------- ---- Date .._...----___-..--_.______._.__._- { SepticTank (Specify.Requirements) ------------------------------------------------------------------------------------------------------ -------------------------- DisposalField Sp ify Requirements) --------------------------------------------------------------------------------------------------------------------•---•----------- �- _ ------------- --------- - (Draw existing and required,addition on reverse side) I hereby certify that l have prepared this application and thai the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District."Horne owner or licen- sed agents signaturecertifies�the following: "1 certify that in jhe 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 ( a - ----<1 Signed -- ----------- --- Owner ° C ?�` By ----- a _ Title 1 ' '--�(If o t an owne4r) ' FOR.-DEPARTMENT..USE ONLY APPLICATION ACCEPTED BY _.__.__-___ ______-------------------- 4 ---------------° ._ ._.._ DATE ._: __.___.77Z..----------------- BUILDING PERMIT ISSUED ------------------------------------------ ---DATE --------------------------- ADDITIONAL COMMENTS - - ------------- . 'rA ,. -----------------------------_..k'« _`----- -------- ----Y---------------:a- ------------------ - _ _-- - ----.__._ . . __.. . __.-----'------ ---------------- - -- --tea---- //�R --------- ---------------- - - R' Final Inspection by: �- ---------------- --- -- --' Date -=�f� - SAN JOAQUIN LOCAL HEALTH DISTRICT E, H. 9 1-'68 Rev. 5M.