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n I PERMIT FOR OFFICE USE: APPLICATION FOR SANITATIONf-7�-- q Permit No: -------------- (Complete in Triplicate) - ----- ----- ----------- --------- --------- p Date Issued This Permit Expires 1 Year From Date-issued 1 - o -C Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in.complianc. with County_Ordinance No. 549 and .existing Rules and Regulations: riurti=yam•, - JOB ADDRESS/LOCATION -: �, -- .�* a(e,(4/0' CENSUS TRACT -------------- ----------- Owner's Name -- -- ---------------- - ----------------Phone ----------------------•------------- s� l�° ------------- City Address ------� '---------------- Contractor's Name --- ��` License #/ ..J.� - - Phone L; ---- Installation will serve: Residence Apartment House-M Commercial ❑Trailer Court l❑ Motel ❑Other ------------------- ------------------------ Number of living units:.___---- Number of bedrooms -- ." _-Garboga rinr dere "- Lot Size _- - -- Water Supply: Public System and name ------ ------4/e --------------------------------------Private E] Character of soil to a depth of 3 feet: Sand'❑ Silt El Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam :❑ Hardpan ❑ Adobe;K Fill Material ----- ----- If yes, type --_---------------"-------- j W ;: (Piot plan, showing size of lot, location of systern in relation to wells, buildings, etc. must be placed on reverse side.) N NEW INSTALLATION: (No septic tank or seepage pit permitted ifpublic�sewer is available within 200 feet,) SEPTIC TANK Size.-,4 ------- Liquid Depth -;: __-------------- PACKAGE " PACKAGE TREATMENT [ � {� -,�""�"" Ca acit Type,��'- 0-- Material .ff .... No. Compartments -." •.-.-----:-••- *-----, Foundation __Xt9------------ Prop. Line a Distance to nearest: Well -----_--"----.---_---__-_- ---- -.------- Length of each line..--�47--------------- Total Length - ",1��---------•---- LEACHING LINE � No. of Lines "__-- - 'D' Box �-.0 Type Filter Material 1 ��1 Depth Filter Material ��- ---------•- Distan� to nearest. Well -"-r ------------ Foundation . -.".------" -- Property Line -s$"------------------ SEEPAGE PIT { * Depth �r�---------- Diameter 13.1&_{ --- Number "._ _------ --------- Rock Filled Yes; No Water Table Depth --_--;�- ------------------------------------Rock Size --- --------------- F r Distance to nearest: Well ------ ' Foundation • Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ------------------- ------ Date ----------------------------------) -------------------- Septic Tank (Specify Requirements) ------------------------- ---------------------------- Disposal Field (Specify Requirements) "__-"----------------------•----------- -----"-- --"------- ---------------------------------------- -------- ---- -- --- - - - ------------- ----- -------------------------- - - [Draw existing and required addition on reverse s d e 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 f as to become subject to Workman's Compensation laws of California." Ii Signed ------ --------- - --------------------------- - -- --- - - --------------------------- Owner --------------------------- Title -------- ------ ------------------ I er than owner) OR DEPARTMENT USE ONLY p r -------. DATE -- =aZ� ' APPLICATION ACCEPTED BY - �.. --- - BUILDING PERMIT ISSUED -------- -_ ------ DATE ------------------------------------------- BUILDING ----------------------------------------------=--------------------------- ADDITIONAL COMMENTS --------�-_ -II'�r ---------��-------�f�--- •=•--"- ------------------------------------------- -- - --------------- ----------------------------------------------------------------------------------------------------------- ------ - - -- --- -------------------------------------------- -------------------- ----------------------------------- -------- -- i Final Inspection b - ------ ------.Date -- � ---- --- -- '- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M