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FOR OFFICE USE: APPLICATIOJJ FOR SANITATION PERMIT -- --- -- -----. - Permit No. .��-.1_`ff--.-- ------- -- (Complete in Triplicate) -- -------- --------------------- -- -- Date Issued This Permit Expires 1 Year From Date Issued ------------- .r 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 ,-�2.6-:O.?,-�-:�-.,- , ,K-/7- ---- ------CENSUS TRACT'- `- 1---.•-- �q�ts '� r _ Phan 6-.j_6.... Owners Name .- - - �-=---�1��--T�'�----------------------------------- ---------- �� �6 3 -- 6 ,S rW7, Mgr = city �'%'r c - - Address . ---_----- -- ------ :.� ,.. �' License 31.3,0 - Phonei 7_`�� Contractor's Name _..- /"'�_ j,�, �----dsIfI1C:S .�? ` Installation will serve: Residence P�Irpartment House-C] Commercial ❑Trailer Court F] Motel ❑Other ---------------- --_-------- ------------ ------------ / /P Lot Size. Number of living units: /._._. Number of bedrooms ....Garbage Grinder.. .__ Water Supply: Public System and name --------- --- -- ....... ------------------ Character ----------------Character of soil to a depth of 3 feet: Sand 0 Sift❑ Clay [9---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,) _// PACKAGE: TREATMENT ( ] SEPTIC TANK [�]'� SizeT.aX_1.-.-1��`_ ------ Liquid Depth . ---------,----- {A� Capacity j �U_,_. Type�� %Sr Material "` No. Compartments --------- + /�, i Distance to nearest: Well _61_2_1 tC�1 . .. ..............-_.Foundation� - Prop. Line _ - --=-----••• LEACHING LINE V4-- No. of Lines - ------ ------- Length of each line .---.---. - _-- Total Length 160_.------.--.---• 'D' Box .. k� Type Filter Material ?6/,C---___Depth Filter Material .11..... ----- ��--•--- ---.-- r Distance to nearest: Well ............ Foundation ------ Property Line .... .................. --O SEEPAGE PIT ( ] Depth __. ---- _..____ Diameter -----_- ----- Number --------- ........ Rock Filled Yes ❑ No Water Table Depth --------- -- ...Rock Size -------•--- ----- Distance to nearest. Well ----- -- •. ---------Foundation -------- ------- Prop. Line ----------- ------ REPAIR/ADDITION(Prey. Sanitation Permit# -•------ -------_ ----------- ............ Date ----------------------------------) Septic Tank (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." Sign1D- -- wnerBy - -� r �' <`-'Z--.. ..._ --- Title I other t an owner] FOR DEPARTMENT USE ONLY ............. ........... ----------- .. DATE _. .-`_.I '._ �_ APPLICATION ACCEPTED BY----------foc -L��*�+-�--- -- ••------- - -- BUILDING PERMIT ISSUED ---•---•----•--- ...........DATE -----••------_----•----•------------- ADDITIONALCOMMENTS--------------------------------------------------------- ---------..-._....__------------••--- ............ --------------------•------ .......... -•---------------•-------------------- ................... -----... ---•--------......................................................................... --------------------- .................................. ------------------_-• .-----........ •-----.......__...•------•••-••--•---••---------.---•-----_..._...._..--�-}----- ------------- ...........................................................-----................. ..�I� ��- Final Inspection b . .�t�,�.c-�•-- ........................... ...........Date ---------------- --------- --------•..•- SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M