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FOR OFFICE USE. j APPLICATION FOR SANITATION PERMIT ...................�....:,:............_.....--•- •-�- Permit No.� (Complete in Triplicate) .. ---il Date Issued ll.�!r• ...........^.... This Permit Expires 1 Year From Date Issued t Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein { described: This application made in compliance with C my Ordinance No. 549 and existing Rules and Regulations: �^ p� a ............. CENSUS TRACT ..................... JOS ADDRESS/LOCATION '......�.�.__l............�._....... . . ..... .............. •-- •.�� Owner's Name ... . �i_ � �,o c -----------•- --.P onefs.... ... .................... Y"''' '` ``�` Address n ,� / '�� ;? s . --•--------- City > �G J Contractor's Name � �-�- - `"� :�-License #�z.I9 7�7. - Phone installation will serve: 21 ResidenceKApartment House❑ Commercial ❑Trailer Court -C] Motel ❑Other .... . .........-- -------- C r Number of living units:.._ .. . Number of bedrooms ....._.Garbage Grinder�-_ lot Siz ... ........... .........................•.. _Water Supply: Public 5yste� m and name .. _ _ _... Private,( Character of soil to a depth!of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam [] 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 , ao septic tank or seepage pit permitted if public sewer is available within 200 feet,) e PACKAGI:AREATMENT [ };` SEPTIC TANK T ] Xt /S! W- i --------------- ..............I... ..- Liquid Depth .-..................... Capacity Type - :..----- Material........... . ...... No. Compartments ...................... i Distance to nearest: Well ... ....... ---------------------Foundation ......... ---_-- Prop. Line ...... ............. LEACHING LINE No. of Lines Length of each line d .......;.... Total Length................. 'i i Bax .~., .... Type Filter Material _ ... ._Depth Filter Materia! e� �..__-•-- �"Sfi� / ......... .. .. .- . .. _ Distance too^ nearest: Well .J� .. ........... Foundation -------- V.-.... . ..__ Property Line . .' -- SEEPAGE'PIT �9° Depth .t,G S _-.. Diameter ....f '' -. Number - ---. ........... ...• Rock Filled Yes No Water Table Depth ,� ..r --•-•--•--••-------.Rock Size -. ..:.._------------------- ij f / Distance to nearest: Well . ,.Grp''............................Foundation -A�.. _... Prop. line ... -•-_-_--_ REPAIR/ADDITION(Prev. Sanitation Permit#--------- ------- --.--•-:----- Date .....-_-------_----------------) Septic Tank (Specify Requirements) .........:.............. ....... ---- ........................._......____.............. Disposal Field (SpecifyRequirements) --- -----------------•r----------- ---------------- ................ .._. . . ...................................... ...................... ---•.............................. z ............. ......... ------------------ ------------ ------ ----- -;---...... ...................... ......... - ------ i (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. i 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 - By .. -. . Title . .... G....... ...... (if other than owner) II X FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... ................... ........ DATE ......�.L...`l `1+�•-•- BUILDING PERMIT ISSUED :_........:.DATE ...... ..... ............---------....., ADDITIONALCOMMENTS .......................r.-.-------------- ..... .. ---------------- .--------.--------- ----------- q ................------ ..........._...--- -- ..._...._..----------------------------...... -- ..................._.... F - ....... -- _...... ..... / ............ ----- ..... z W r Final Inspection by: ...... Date -.. .:....... ----- - SAN JOAQUIN LOCAL HEALTH' DISTRICT i c u 13 .24 1_'Aa up,, in� 7172 3 M _