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FOR OFFICE USE: APPLICATION I:OR SANITATION PERMIT �7 ------------------ ---------------•------------- Permit No.? -7 ,, (Complete in Triplicate) ---------------------------------------------------------- _________________________________________________________ This Permit Expires ] Year From Date Issued Date Issued _-- OS7r ].Sn�!l 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 exis 'ng Rul d Regulations: 17 � Y � CNS 5A `S-JOB ADDRESS/LOCATEN 1:Z117 Owner's Name -----/ --- ------- / --- -------------------------------------------- -------------------Phone ------------------------------------ Address .......... ~� ! `r --------- �� - ------- ---- --------------------- City g�� -- Contractor's Name ---- ---------------------- --.License # -------- --------------- Phone ----------------- Installation will serve: Residence ❑ Apartment House-[:] Commercial ❑Traller Evart ;141 Motel ❑Other ----------------------•--------------------- Number of living units ----- Number of bedrooms ----d_2.-..Garbage Grinder -------- --. Lot Size --- � --------------- ---------- Water Supply: Public System and name --------------------------------------------------------------------------------------------------- --------•-Private Character of soil to a depth of 3 feet: Sand'o Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam; '1 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 SEPTIC TANI<j� Size_-a-'�'� ----------------- Liquid Depth ------y-..-.-.--- Capacity /.2—_ .... Type _.. Material-_ ---------- No. Compartments .-,;'"--------------- Distance to nearest: Well ___ -_------------------------Foundation -10- Prop. Line ._..._---......._.._. LEACHING LINE No. of Lines ---------------- Length of each line..._/.d.-37.............. Total Len th _ "�� o, D' $ox --- ----- Type Filter Material _ '__ '...Depth Filter Material ----f .__. _---------- --------------- -- B o)*- --Distance to nearest: Well __'4_P-------------- Foundation ----/__d------------- Property Line 4 .--.--------------. SEEPAGE PIT A Depth Diameter - -�_f_.... Number __ _ F_.--_.._..-. Rock Filled Yes No i❑ /' Water Table Depth ---f a�� f----------- ------------------Rock Size � � � ed-------•--••-- Distance to nearest: Well ---« ---------------------Foundation _._f_a----------- Prop. Line S.-..-----......... REPAIR/ADDITION(Prev. Sanitation Permit# -•------- ---------------------------------- Date ----------------------------------) t> Septic Tank (Specify Requirements) --------------------- ---------------------------------------------------- DisposalField (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. Home owner or Him- 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 mannee as to be. a sub' to s Com ensa ws of California.". p Signe - --- ---- - - .-- Owner B --------------------------- ----------- Title - ---------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------------------------- DATE _. -�f '-� '.---- --------- BUILDING PERMIT ISSUED ---------------------------------------------- ----------------DATE ------------------------------------------ ADDITIONAL COMMENTS -------------------- ------------------------------------------------------------------------------------ ---------- ---------- ------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- --------------------------------------------------------- --------------- -------------------------- - - Final Inspection by: . ---------- - --Date Z- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M