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FOR OFFICE USE: J. APPLICATION FOR SANITATION PERMIT r 3 Permit No, ------ f�'�`1 ---- --- ---- -` �"'" ----" (Complete in Triplicate) ------------------------ -- --- -•-- ------- --------- " Date Issued -------1-------- This Permit Expires 1 Year From Date Issued d ____ ----------- 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 ex' i�Rukes and Regulations: Aeh6l_ CENSLfS TRACT -------------- ----------- JOB ADDRESS/LOCATI N .- ------ �---`---z-- - -----(71�- Y � Owner's Name - j Phone ---------------------•------------- j Cit 1i1 -J _" Address - (� T,n IX" fit ._ ------.License #� T.'a -/- Phone - 6 1,17 Contractor's Name -------- -- -- --------- ----------""-- Installation will serve: Residence rtment House[:1 Commercial❑Trailer Court ;❑ � /V /Ou I Motel ❑ Other -------------------------------------------- Number ------------- ----------------------------Number of living units:-"__1_----- Number of bedrooms _____I----Garbage Grinder --- Lot Size -- Private � Water Supply: Public System and name --------------=-------- - ----------------- ---------- ------- Clay ❑ :❑ i Character of soil to a depth of 3 feet: Sand' � t❑ ClY ❑ Peat❑ SandY Loam Clay Loam 4 Hardpan ❑ Adobe ❑ Fill Material -/-Vd - If yes,type ----------------"------ l I (Plot plan, showing size of loft, 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 PACKAGE TREATMENT Y] SEPTIC TANK I ],i' Size Liquid Depth ,� _ Material_ 1iG^r 440. Compartments _ ' Capacity ._>��?�---- ---- Type � - ` /' Foundation ..../_0 Prop. Line _ .. - ' Distance to nearest: Well _ __-60 l---------------- � ------ f / i LEACHING LINE j' ] No. of,Lines _._-_ "_ -' Length-of line__--_.__!_ Q .---"__ -- Total Len th :_ �_----_ _ �. --- D' Box AJ.6-- Type Filter Material---_f__ cf� pth Filter Material- ----- Distance _L- _------------- Property Line .� ------------- I � Distance to nearest: Well __ Q----------- -- N%. Depth Diameter ______----- --- NUmber _-."----"------- --------- Rock Filled Yes ❑ No C3 SEEPAGE PIT [ ] p .-------- Water Table Depth ____"__Rock Size ______----_____.__---''------ I -----Foundation -------------- ----- Prop. Line ---------------------- Distance to nearest: Well ---------------------------- Date ' REPAIR/ADDITION(Prev. Sanitation Permit# -- - . - i 1 Septic Tank (Specify Requirements) ' --------•----- - ---------------------------------- ---------- Disposal Field (Specify Requirements) ------------ -- - ---- ------------------------------------- ------------- ------------------------ ----- = ------- --- - ----- --- - g ' req' t t side) t * (Draw existin and wired addition on reverse .I hereby certify that I have prepared,this application and tha a 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." f - Signed - - ---- ------ _ _ r` C __ '` _ _ Owne -- ---- ------ -- - ---------------------------- ----------- ------------------ By —Y - itle -- ----- I(If of er than owner) FOR DEPARTMENT USE ONLY '-"r DATE ---------------------��--�F---------------- r APPLICATION ACCEPTED 13Y,; '----- ---- - DATE ---------- ------------- BUILDING PERMIT (SSU f ADDITIONAL�.COMMENTS -----`---------------------------------------------- - ----- - ---"---�----------=---------- :._..�..._..r-.-.-„tet - - ---------------------- ------ ------------------ ----- ---- - - ------------------------------ ------------------ " '� --------------- --- --------------------------------- - -------------------------------------- - - ---Y -__ __ ----- _ _ _ --------------------------- --------------•------- Date --- -- ---- -r�--•�1 I Final inspection by. d SAN JOAQUIN LOCAL HEALTH DISTRICT F E. H. 9 1-'b$ Rev. 5M -