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FOR OFFICE USE: WLICATION FOR SANITATION Ptd' ' ..-------- - - ............." - ----- ... (Complete in Triplicate) IW Permit No. . ^ ' C SCJ ................ . - _-- ------------ This Permit Expires 1 Year From Date Issued 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 ADDRESS/LOCATION __�''� �. ENSUS TRACT Owner's Namic �.. - hO ---- ...P L� Cit --------- --------- -Q-t'v.�_. !- ------ -------- .... y � Address - Contractor's Name -----s�_ r� 4-- ---- _`: -. "`� icense # -�C� �I Y Phone ----- -----_--- Installation will serve: Residence Apartment House Commercial ❑Trailer Court :❑ Motel ❑Other Number of living units: ..- Number of bedrooms ---Garbage Grinder .....—_ - Lot Size ....-------------------- -------------- Water Supply: Public System and name .... - - ------------ --- Private .r Character of soil to a depth of 3 feet: Sand'❑ Silt❑ 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 seepage pit permitted if public sewer is available within 200 feet,) f/ /X"��`- PACKAGE TREATMENT [ ] SEPTIC TANK[� Sizetl�-- ---�'-5-------"... - . Liquid Depth q..J. ................... Capacity [R;P_V---_--- TypeLQ- -_. Material_iC No. Compartments v --.............. ! S" Distance to nearest: Well -------..- -c�?------------------Foundation ....--1.�. .- ---- Prop. Line ---------------------- f LEACHING LINE [y No- of Lines . . 02-*............ Length of each line . 10<-- ------.------ Total Length ...v).C.0-------------- - ' 'D' Box - Type Filter Material .:.....Depth f=ilter Material --------------- s Distance t nearest: Well ---...�.80___._..... Foundation -----1fJ............... Property Line ___-....--__....--.-..-- � SEEPAGE PIT [ Depth - -c2XI------- 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) -------- - ----------- ------------------- ----------_--------------- - ------ ------------------ ..----------.... .------- S Disposal Field ISpecify Requirements] ----------------------- ------------- ------- ----------- ---------------------------------_---------------- -- --- - ----------- f ' --- - .............. ,1 (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 C 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 Owner --------------- ----- .. - Title . lL..•l- ¢ st-#s...... .. ......... . i (If other than owner) FOR DEPARTMENT USE ONLY -.l - r� APPLICATION ACCEPTED 8Y - - - ----.------.... - - ----------- DATE � ... --- --� .- --- --- BUILDING PERMIT ISSUED .............. .. --- ------------DATE .. . ... ---------- -- ------- ADDITIONAL COMMENTS ....... ... .... ----- ...... .. -------_--------- ----------------------------------- ------_--- ---............ . .. .. . - ----------- ---------- - --- ------------------ - ------- --- --- -------- -------------------- ------------- ......---- ----- -- - Final Inspection by: . --- ------------------------ -- -----. ------ ---------Date 7 ./.. .- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M