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FOR OFFICE USE: ��PPLICATION FOR SANITATION PEKJ (Complete in Triplicate) Permit No: - --------------------- _______________ This permit Expires 1 Year From Date Issued pate 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. �L J08 ADDRESS/LOCATI N IIf_ �=_ CENSUS TRACT _./ - Owner's Name l�-vt o------- c !�'-�----------------------------------------------.--c -- Phone c3y__�3_/lam p Address 1 y`�--------5-----•_ ! _��------------• city ----F 09Z_q-/-------------------------------- Contractor's Name ---------------------------------------------------License # ----=----:-------------- Phone -----------•------------------ -# Installation will serve: Residence ❑Apartment House,❑ Commercial ❑Trailer Motel ❑Other__ ------------------------- .� Number of living units______ _____ Number of bedrooms ---3 N---_Garbage Grinder ---_ Lot Size ! . Water Supply: Public System and name ------------------------------------------ ----------------------- ------------------ ---------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Wo Clay ❑ Peat❑ Sandy.Loam •❑ 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 INSTALLATION: (No septic tank or se page pit permitted if public sewer is avail ble within 200 feet,) I 1 PACKAGE TREATMENT [ ] SEPTIC TANK+[ Size---------------------------------------- ------ Liquid .Depth ____._____-___.._-.__-___. Capacity ------------------ - Type -------------------- Material---------------------- No. Compartments IDistance to nearest: Well _________________ __-_______Foundation _._ _-----_--___-_____ Prop. Line _-___--________....... LEACHING LINT: [ ] No. of Lines ----------- ----------- Length of each fine--------------------- ---- Total Length _____-__.----------__..._. 'D,' Box ------------ TYp Filter Material --------------------Depth Filter Material -------------------------------------•-,_--- Distance to nearest. ell ------------------------ Foundation _______________ ________ Property Line. _--___-__________--_.._ e SEEPAGE PIT [ ] Depth_ _______________-_-_- Diameter ---------------- Number ----------------f____ Rock Filled Yes '� No f! Water Table_ DePt ----------------------------------------------Rock Size --- ---------------------- Distance to nearest: II ________________________________________Foundation -------------- Prop. Line ________-_--- ........ ; i REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------.-------------------------} ! Septic Tank (Specify Requirements) � Dis osal Field (Specify Requirements) -4_Q12....._FEP66 _� 1 y I % I f r^ ' � �f I ---------------------------------------------------- --------------------------- --- ------------------ s -------------------------------_------------------------------------------------------------------------------__---_----__-_____-____________________________-___--.__--_________________---_-__-__-__-_- (Draw existing and required addition on reverse-side) I hereby certify that 1 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 agen . signature certifies the following: "I certi y t in the performancg of the work for which this permit is issued, I shall not employ any person in such manner as to bkccirn# subject rnt,,n'sCompensation laws of California." Signed 'L `LOwner ------------ -------------------- -------------------- SY -------------------------------------------- -- ! c Title ---------- ----- i - -------------------- - (If other than owner) i �- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------------ ----------------. DATE ----- C , COMMENTSPERMITBUILDING _f a �zxzr �t A--T--E---- ADDITIONAL - _ -------------- ------------------ ----------------------------------------------------- -------------------------------------- -----------------------------------:--------------:------- - ------------------------------------------- ---- 2z --Fina] Inspection by: ___ -------------------------------------------- --- - pate ----- _V _ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9. 1-'AR Rav 5M