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FOR OFF.I C6 USF_: /r(�' ' J :APPLICATION FOR SANITATION PERMIT ----------------------------------- -------------- . : ``,.:. Permit No: .6 __- 5� r (Complete in Triplicate) -------------------------------------------------------=-- This Permit Expires 1 Year From Date Issued I 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 existin Rules and Regulations: JOB ADDRESS/LOCATION -- ---- � ---- - - -- `- H j�=j -------CENSUS TRACT --------------`---------- -----------I Ioq-1 Owner's Name --------4 - -------------------- --- -------------'-------------------Phone Address --- ------- -3-1-- -�3._------1 ._I ►: _ ----------------- City _-��TO_CK Nl --------------------------------------- Contractor's Name -.--r!-WN_E-R__-----------------------------------------------•-=-------.License # -:---------- -- Pone ------------------------------ 'r Installation will serve: Residence E]Apartment Apartment HousCommercial : railer Court C] Motel f-1 Other --------j fJ ---�� ------- Number of living units:--- ---- Number of bedrooms"--____.--Garbage Grinder - ---------- Lot Size __1 _____--____ Water Supply: Public System and name ------ R---------------- --- ------Private ❑ s Character of sail to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam;❑ _ _.-.. _ Hardpan.❑Y _Adobe❑ _Fill_Material------------- If_yes,_type-- = �,a (Plot plan, showing size of lot, location of system in relation to w'slls, 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 ---------------------.----- kf J Capacity -------------------- Type ------ ------------- Material---------------------- No. Compartments -------------•------ Distance to nearest: Well -----------------------------------•Foundation ---------------------- Prop. Line ------------ LEACHING -_-------LEACHING LINE [ ] No. of Lines ----------------- ------ Length of each line---------------------------- Total Length ------.----.----------.._--- 'D' Box ___ ------- Type Filter Materia! ____________________Depth Filter Materia! --------------------.-----------.----------- ____ . .Distance tc nearest-Well-^-.'"__�-------'Foundation---__---- Property--Line--_____________________ k SEEPAGE PIT' [ ] Depth -------------------- Diameter ........._ ---- Number ---------- ----------------- Rock Filled Yes F] No 011 Water Table Depth --------------------------------------- ------Rock Size- '---- f--------------------- ---! "' :--•--.Foundations----------------- l?•� Distance to nearest: Well `---=----_.-- _ Pro Line ---------------------- ' REPAIR/ADDITION(Prey. SanitationTPermit# Date t Septic Tdnk (Specify Requirements) --�> ` 1_ lA( --_ ----- Disposal Field (Specify Requirements),--_.5E—lP -!- 1 it ' f r"r poP � r�u s -----�JFFE--�---- FJ_.�,1X D_A_± +l_G.!_f-V- ------rlf "----Y_['""'------------�E-� ----C7-��- '_'_�- 1 ------ --•------- ------------- �(DraWexisting`and required-addition on reverse side)- I hereby certify that I have prepared-this-.application_and_that_thework will be done in accordance1wrtit San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or liken- sed agents 09nature certifies the following: "i certify that in the performance of the work for which this permit is issued, I shall not employ any persona in such manner as to beco e s t to orkman' 5pmpensation laws of California." , Signed .(1e2 ---=--------------- -- --- Owner fes' ------------------------------------------------------------ Title ------------- --- --- -------------------- ----------- ` .-=-------- (if other than owner) I- FOR .DEPARTMENT USE ONLY � I APPLICATION ACCEPTED BY cr °------ ---------------_ - - ---- --------------------------- DATE ----> � �` T^' BUILDIl` PERMIT'ISSUED--"�"" --- - � �----- ---DATE_.._-. ------------------------------ ADDITIONAL COMMENTS - - -----fA-`Sr _r - ----- ------------------- ----'--- ---------`---------- - -- ------ --- ----- - - --- --- -- ' - -------------------- -------------------------.__------------------------- - - - --4 --------- f ------------------------ Z Finallnspectioni Date --- -----_------� ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M P f P