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FOR OFFICE USE: ",pPLICATION FOR SANITATION PER'"T D . . - -------------------- wx7�✓J (Complete in Triplicate) Permit No. __------- ------ This Permit Expires 1 Year From Date Issued Date Issued __-.. _.._.. Application is hereby made to the San Joaquin Local Health District for at to construct Jn install the work herein described. This application is made in compliance with County OrdinanceF149 and existing ules and Regulations: JOB ADDRESS/LOCATION ----1.�I� _,_.------St-4—f VTA__-_-F>�-------------------- CENSUS TRACT ---- Name ----------_ -Phone Address _ J-:1.q_Q. �?-�-,-``_]fuF_ S�NTI� F�-- ------------ City --- r S-C_ _L- �V ---------------- ---•---------_----- Contractor's Name ------_C� l . �__`----------------------------- ----- ----- License # -_ --- Phone ---------------- ----------- Installation will serve: Residence R-4"artment House❑ Commercial ❑Trailer Court f❑ Motel ❑ Other _ _ . .-..------ - ---- -- ------ ' Number of living units---.--t Number of bedrooms e -Garbage Grinder _ Lot Size ____4C_ FT _--_--__-- Water Supply: Public System and name . ..----------_.-_ -------_---___-_.--____._'__..-..-------......Private ©/ Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ FillMaterial /V0-__ 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 available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size________ ______ . ... Liquid Depth ---- _.--_-- -- -_.--- -- - ----------------- Capacity ------- ----- --- Type - Material- _ - - No. Compartments --------............ Distance to nearest: Well _ ____ ____. -- . __.__--_ _ _ Prop. Line -------------_-----_- LEACHING LINE No. of Lines -- _ _ .--.._ Length of each line __ _ Total Length . ------------------------ Dj Box _ _-__- Type Filter Material Filter Material _____ ___.__..__------------------------__ Distance to nearest: Well -.___._ ------------- Foundation __ _ Property Line . ...................... SEEPAGE PIT [ ] Depth _ _ __ __. Diameter _ _ ------ . Numbe _. Rock Filled Yes ❑ No C] Water Table Depth -- - - -_ - - ----------------------- Rock Size - ----------------------- Distance to nearest: Well -------- --------------_--_------Foundation -------------------- Prop. Line _-_._-_______________ REPAIR/ADDITION(Prey. Sanitation Permit# -------- .__------ -- --- -- Date __.-.-._.___------------------) Septic Tank (Specify Requirements) ..----------- ------- - --- --- --- ----- ,f.�- (--------------------------------------------------------------------------- Disposal Field (Specify Requirements) __Q( __' USC___._____ --____e1� _.__/Ff}C:14.__L1.1_�/_�_---_------ --------- !.I? .--`----- --- t TH LINA �— �f� t�/�(�°1 � 1'I •_ - x --- X - = - --- ------- ----- - - - - -------------------- - - -------- ------ -------- (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 si nature certifies the following: "I certify th t in the performancework for whic this permit is issued, I shall not employ any person in such manner as to bec elsubject to Workman' Compensation la o lifornia." l - Sign d Aw -- . -�--- -- Owner BY -------------------------------------- ----------------- �� Title ----------- ---- -- ---- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY :-i.__T1 *V.c-._-.: . - ---------------------------------------------- ------------ DATE ..- --------- BUILDING PERMIT -ISSUED -------------- -- --------------------- ---------- ----DATE ------------- ---- ADDITIONAL COMMENTS ------- ------------•------------------------ --- -- --------------------- - ------- - -- ------------------------------------•---------------- r ----------------------------- ------ -------- ---------------------- -- ------ -- ----- -- ---------•----------------•---------------------------•---- ----------------------------------- --- --- ----- -------- --- -- ---- ----- ----- - -- - ------------------•---------------- �------------ Final Inspection- ----- Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M