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FOR OFFICE USE: � APPLICATION FOR SANITATION PERIIt�T // -- --- ----------•------------- Permit No. -6----9S. (Complete in Triplicate) ,,,-_ __ __-__--_- This Permit Expires 1 Year From Date Issued Date Issued3-�-O---- 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 Ordinanc No 549 and ex'sting Rule and Regulations: JOB ADDRESS/LOCATION . r .... lj�� - ,e ' ��J.j!/ s TRACTG __ Owner's Name .. � p --------- Phone -------------------- ---------- *-11 -------- ` tl / Lr City --- - --- ......-- Address ----- `0x-'7V-----G '1 Contractor's Name ----- � r-------------- -- ------.License Z - � _ Installation will serve: Residence ❑Apartment House Commercial ❑Trailer Court ❑ /f Motel ❑Other -,df112 _. /2 Number of living units:---- Number of bedrooms _j----_.-Garbage Grinder/-V-a--- Lot Size CGS.X,0 :-.----- low Water Supply: Public System and name - ----------------- ---------------------------------. - --------------------------------=---------.Private 2 ' Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam' v Hardpan ❑ Adobe ❑ Fill Material .----------- If yes,type (Plot plan, showing size of lot, location of system in relation tor 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 TANK Size- /_ /�- -AF- -- -e_- Liquid Depth Capacity _/,�,B�J._ Type�L- —A- Material_eRZ7i --. No. Compartments ._ ---.--.:---. Distance to nearest: Well --------------------Foundation o_--------------Foundation -Z;9- --------- Prop. Line _20------------ LEACHING LINE No. of Lines ---o�&--------___. Length of each Iine...,7.J_ .------- ------ Total Length --�iS_Q.--..--._- n 'D' Box �/0--$- Type Filter Material � _ -Depth Filter Material A�_---_---_-_----------------_.. Distancee to nearest: Well .,C,PQ_----_--- Foundation ca2�._...._._.___. Property Line z d•_---..._.--. t SEEPAGE PIT [ ] Depth ----_ ------------- Diameter ---------------- Number - -- --------. Rock Filled Yes ❑ No u 1 Water Table Depth ----------------------- -----------------------Rock Size ----------- ------------------- S Distance to nearest: Wel[ ----------------------------------------Foundation ---------- --------- Prop. Line --------------- ...... 1 REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------------------_.-.-.-- Date ----------------------------......I SepticTank (Specify Requirements) - ----------------------------- -------------------------------------------------^------------------------�•--- - Disposal Field (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 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 as to become subject to Workman's Compensation laws of California." Signed -------------- - - ZEPARTMENT ----- Owner ,,,,I,��s ------y- By _.-... - '- - - - - -----�--- _--. SiTle -------- - - - -!/al�+�- ------------------------- (If r Than owner) FO USE ONLY .� APPLICATION ACCEPTED BY =` ---- ----------------------------------------- DATE ------ ---------- BUILDING PERMIT ISSUED --- ------ ---------------------- ----------------------- ------------------------------------DATE -- --------------------- - ADDITIONAL COMMENTS ------ --- ------------------------------------------- ---- ----------------------------------------------------------------------------------------------------------------------------------- ----------------- - - ` --------- ----------- ------------------------------------------------------------------------------- -- --------- ----------------------------------- --- --- - --D---------- 1- - Final Inspection b ate ---- . -- ---- ----- .----- ` SAN JOAQUIN LOCA HE H DISTRICT c u 0 1 'ac 0.... GAA