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I FOR OFFICE USE: APPLICATION FOR SANITATION PERT = Permit No. (Complete in Triplicate) F # Date Issued --------------------------------------------------------- This Periimit Expires 1 Year From Date 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: JOB ADDRESSAOCATION . - �#/yT� ----- J 1�/ 3 E SUS TRACT --------------•----------- Owner's Name __ _ ------ ,Crl1QGlT ------ --,- -/�"- - ---J -----------------Phone--------------------------------._... Address ---------��►'a�� )� �� J'J ; r � •--. City Contractor's Name --- -----`-4--epallew-------------------- --------.License # -�, ' p`�. Phone Installation will serve:, Residence.❑Apartment House,❑ Commercial : Trailer Court Motel ❑Other Number of living units:----/-____ Number of bedrooms ------ Grinder ------------ Lot Size -------------- ------------•-•-•------------ Water Supply: Public"System and name __________________ ______- Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ HardpanE]- 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 avail ble within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size___'jr�iz� " - liquid Depth ---"��f------•--•---- Capacity _/P------.-- Type !p=-X GA$"Material---------------------- No. Compartments -------;.----------- Distance to nearest: Well ------------------------------------F dation +a Pro �.--- � �--�----- - p. Line ---��--�.:-•--------- � LEACHING LINE { ] No. of .Lines -----t2-- Length of each I%ne____ __ ___ /.Q Total Length s -_v-C�0 'D' Box _ J--____ Type Filter Material 1/_6JV4t��_Depth Filter Material -----Zr1___-------------------------- Distance _____-_-Distance to nearest: Well ________________________ Foundation ------------------------ Property Line __-_--__-______---:..__ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number --------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------ 9 -----------------------------------------Rock Size --- ----- - _ _ -------------------- -- 7 Distance to nearest: Well __________________________________ ____Foundation Prop. Line _..---..._.._........ REPAIR/ADDITION(Prev. Sanitation Permit# --------- ----------------------------------- Date .-------------------_---------•-•-) Septic Tank (Specify Requirements) --------------- --------------------•--------------------------------•-------•--- Disposal Field (Specify Requirements) --------- -------------------------------------------------- •-------------------------------------- ------ ---------------------------- ------------------------------------------- -------------------------------------------------------------- '-------------------------------------------------------------- ---------------- ------- (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 agents signature certifies the following: "I certify that in the performance of the work for which this peceYit is issued, I shall not'employ any person in such manner as to become ruble to orkm 's Com ensati.on laws of California.- Signed - -- -------------- Owner alifornia."Signed _- Owner BY --------------------------------------------=--------------- ---------------- Title --- --------------------- (If other than owner), FOR DEPA.RTMEJNT USE ONLY APPLICATION :ACCEPTED BY ---------- ----. DATE __-_-- -- --Z Y/ ! d BUILDING PERMIT ISSUED = DATE --.-- ---•-•-------- ------- ADDITIONAL COMMENTS ____� -_}--.____ ---------- --------�----- - --."""'�'-----4----- ffjf�/ ----------------- ---- ---- - ---- ------- -- ---------•------------ - ------------------------------------------------------ _ - - - .. r; .. i - fFinal Inspection by-- ------------------------- --------------------------------------Date _ _ �� ---- -- ---------------------- SAN JOA UfN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M