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FOR OFFICE USE: x PPLICATION FOR SANITATION PERPL° T •----------------- ------- (Complete in Triplicate) Permit No. -------------------------•------- - Date Issued :�--:��1-`•- This Permit Expires 1 Year From bate issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 an existing Rules and Regulations: XR------ ------- CENSUS TRACT -- JOB ADDRESS/LOCATION .-�----_vZ__-7 e-s---_�----- -� '------- K2 -.-Phone ------------------------------------ Owner's Name -----�----_---- '"-��'__�s�-,_�_ --••`-`-------•-----•- � Addresses _ ._ _' Cit --�- _ f ---- t� �i '' Y ---L1'��y--- Z j tjc 1C -License # faze-/7c� Phone - Contractor s Name __"_� �.-___-��- -------- Installation will serve: Residence`R(Apartment House-[] Commercial []Trailer Court ❑ Motel ❑ Other --------------------- ---------------------- ----------- Number --------------------- `.._Gdrba �5 Number of living units:_____!_____ Number of bedrooms ___ ge .Grinder ____--___-_ Lot Size __"__S._____ _____. Water Supply: Public System and name ___ Private Character of soil to a depth of 3 feet: Sandf] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type .------------------------ (Plot ----•---- -(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_,) 'V! r $ r -------------- Size--- PACKAGE TREATMENT [ ] C i 5EPT1C TANK' _� Liquid Depth ----- Capacity ' p y -D._ _-- Types_-- - Ma#aria) ��I?_G_-_------.No' Compartments ------- ------- ' __.Foundation - - , Distance to nearest: Wel[ :��_ _____________________ /..��------------ Prop: Line _�__.�V00 � r F P LEACHING LINE No. of Lines __- ------------- Length of each line-.-'" . '.-- - Total Length��__. - -l-j 'D' Box ____ ---- Type Filter Material )ro �Depth Filter Material ___ ti i Distance to nearest: Well -�?-L7---------- Foundation -G- ------------- Property Line �. � ----- SEEPAGE PIT [ ] Depth __ Diameter ________________ Number ___._._.-.-._.__ ______ Rock Filled Yes ❑ No ❑ , ------------------- Water Table Depth ------------ ------Rock Size ------------- ------------------ Distance to nearest: Well ____..__"___________ ------------------------ -----Foundation ---------- ......... Prop. Line -- ---------• ------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------------"--------) Septic Tank (Specify Requirements) ----------------- ----- --__.- Disposal Field (Specify Requirements) ___._______ _ --------------------"---------------------- -------•---------------------------- ----------------- -----------------------------------------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. flame owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such Branner as to be e s Weq t Wo an's Com sation laws of California." • -------- Owner Signed - - - �'`' 'S-- `� -------- ~'` P ' }-' -------------- Title . (If other thary owner) FOR EPARTMENT USIE ONLY 1 �'� APPLICATION ACCEPTED BY -= ---- DATE - BUILDING PERMIT ISSUED ---- ------------- DATE ADDITIONAL COMMENTS -------- --------------- --------------------------------------------------- ------- --------------------- -------------------- -- - -a- - --- - - -=------- ------------ -------------------- ------------------ --------------------------------------- ---------------------- -- - -- - - ---- �D-ate --- -- Final Inspection b --------------------------- -- - - SAN JOAQUIN LOCAL HEALTH Dl ]CT E. H. 9 1-'b8 Rev. 5M -