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FOROFFICE USE: 4 . _ � ----- -------------------------------------------------------------- -------------------------- 1 APPLICATION FOR SANITATIONN PERMIT �- Permit No: {Camlate in Tri ) --------------------- - - - ' - - '""`- "�:- Date Issued _------------------- - This Permit Expires'1 Year From Date.Issued ,w 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 ADD RESS/LOCATION:_el-0 ___ _ _- ___- f2_ J_-_ _ ___-----------_------CENSUS TRACT -----5'-_5........ 0 Owner's Nam C.1 ` � � —------- --• ---------------------------Phon Addres o � ---- G -Yl - -------------- Cit G Contractor's Name-------------- -=----•------------------------ - ----------------.---License # -----r ------Phone --------------- .............. Installation will serve: Residence Q'Apartment House-[] Commercial❑Trailer Court `,❑ Motel ❑ Other - ------------------ Number of living units:- Number of bedrooms -::;-'.---Garbage Grinder __ Lot'Size -RgF-1G--�-___________ Water Supply: Public System and name -------------------------------- ----------------------------------------------------------------------------Private & Character of soil to a depth;of 3 feet: - Sand'❑ Silt❑ Cla.y ❑ Peat❑ Sandy Loam '❑ Clay Loam - - .� ;r 4 Hardpan ❑ r Adobe ❑ Fill Material ____ _(/___ If yes, type ---------------------------- ' (Plot plan, showing size of lot, location of system 'n relation to wells', buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seep a pif-permitted if ublic sewerjs available within 200 feet,) t ",X]11-!?_ , s PACKAGE TREATMENT [ ] SEPTIC TANK'i ,^'_Size__ _ _]1,____ ______________ Liquid Depth __ _________________ -r. Capacit10 . y -�.��_5�7ype __��i ��Material__}�V�?��D_ No. rCompartments � ___._.- 1 ; ! y 00 Distance to nearest: Well _lao____---------------------Foundation -----.1�__�`-Prop. Line ----=_��_-�_---__.__ LEACHING LINEf.. No. of Lines -.5--------- Length of each line_ _I_______________ Total Length Z� -_-..---.-.._-__ D'. Box -1-------- Type Filter Material �Q---------------------------- . yp: _____-pepth Filter Material __ , r Qistance to nearest: Well _E_________ Foundation ---/Lf.___ =__ Property Line ____________ ! SEEPAGE PIT [,] Depth Diameter ^______________ Number __ _.____._ '------- Rock Filled Yes ❑ No • - Water Table Dept`-----y----------------------------------A -~Rock Size -------------------- Distance to neare'gf. !. :---------•--------•---Foundation '------------------- Prop. Line .......... . REPAIR/ADDITION(Prev. Sanitation Permit#Wel_________ ________`�4r •[ r, � � Date -----^�y:-�--__._--------1 r Septic Tank (Specify Requirements) - - ------------------------- --------------------- ------------------------------------ Disposal Field (Specify Requirements) ------------ ---- ------------------------------------------------------------ --------------------------- I x 1 _ f (Draw existing and required addition on reverse side) ' E I hereby certify that I have prepared this application and that the work will be done`in accordance with Son 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: . "1 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 G` 01. ------ - ------------------------- Owner I By -- ------- --- Title . i " --------_--- -------------------------------------- (if other than owner) I E FOR DEPARTMENT USE ONLY ` f APPLICATION ACCEPTED BY ---- /r, R lam]:,= QATE . l_= 7`. - ------------------------------ BUILDTNG'pERMl7 ISSUED.; -- -------- ------ ---------=--------- -- ------ ----------- --- ----------------- -----------DATE ------------------------------ --::------- r ADDITIONAL CbMMENTS = -` � , ------------------------------ - ---- ---------- ------- ------ --------------------- -------- - ------- ----------------- == -------------------- ---------------- = - Final Inspect! _ F Date -- - ------------------------------- ---------- --------------- ------------ ' Io SAN JOAQUIN LOCAL HEALTH DISTRICT a4' ` E. H. 9 1-'6 'Rev. 5M .. `