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- � I FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7S � (Complete in Triplicate) Permit No. ... ..... ...... 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 ad3e t comp�ce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION /��_fr�YYC'-N..��._.`` I?I-PLF%'7 E�YTJ9/rr.s'....5�'�GYCENSUS TRACT .......................... Owner's Name -.f�?.9�1.T.E4'f_._..L.��1/I..F/.�.J ..._.�SC.t�Q�4.........._1�_.i�`'�.................Phorte ...•....•.................... Address ........ . . ----... ... . ....................... ....... ...............................City ..................................... Contractor's Name ..��/1- / Z?..__cS4�1.�...-..1NG .............License # 24,5__V1..7.3.._.. Phone Installation will serve: Residence❑Apartment House[] Commercial[]Trailer Court 0 Motel ❑Other .........;;�IPC e19;' Number of living units:............ Number of bedrooms ............Garbage Grinder _........... Lot Size .....-...................................... X3, Water Supply: Public System and name ........ ..........................................._........----.......... .....................•••-•-.PrivateX Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay ❑ Peat❑ Sandy Loam 0 Clay Loam❑ Hardpan ❑ Adobe Q 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 I ) Size._..�Q�Q.____.gi_cr_4...._........ liquid Depth .......................... Capacity e!- .-.-.A4LType _. - 7-Mgterial-_ ti�G '� No, Compartments :`-........... Distance,to nearest: Well ..../P4.-s•.--•.............Foundation ..._f.ZVf>_'_... Prop. Line _../p.CJ._►__.__. LEACHING LINE No. of Lines ....... Length of each line...---/ULA._'.------- Total Length ......6.C2_Q_'__.___- 'D' Box ._74r!-. Type Filter Material Depth filter Material ............./._..?._°_..__............. Distance to nearest; Well ---i,�iP4P.......... Foundation ....�-P._a- Property Line ........ SEEPAGE PiT Depth _--_21,1._...._. Diameter Number -----. _A. ------ ...... Rock Filled Ye3X No ❑ Water Table Depth -----------------------------------------....Rock Size ._..._.•.--.--•_-----------••_•_ Distance to nearest: Well .................__'-'.................__Foundation _--- ............... Prop. Line __-_ -_..-------.._.- 1- RIPAIR/ADDITION(Prev. Sanitation Permit 3# _.._.._...... .............................. Date ............._.................. ..) SepticTank (Specify Requirements) ...........................................-.......................................--........................................................ Disposal Field (Specify Requirements) ....................... .................................................-.--------.__..- .-----------.-- ..•....................•--------------...-......-----...---------•-----•--.......----------•....•---------•------• ........... -----------•----------- ---........ ................................ ' t - ...........................----..........................---............. ------------ -•----•----..._.._......... . (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.,Distdcf. Home owner or Ilsen- sed agents signature testifies the following: "I certify that in the performance of the work for which this permit is Issued, l shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." ' Signed ._.. - _ - ' ......... Owner B /..... -�-�t. . Title --------- ................................................... .... (If other than owner) r2OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---C":._. DATE .I ..�j� --' ..--•.................: -• -------------------------------- BUILDING PERMIT ISSUED ------------------- ................. DATE ------- ......................... ADDITIONAL COMMENTS ------------------------------------------ -----------........_....... ............................................... -------- .....-•---------...... ........................................ ..............................___...................... -----------....................................:.r... ---------....................------------ ----- ---------•--•---•- ............ ....... -- ...................... Final inspection by: .............�. - Date EH 13 It 1-b t3 itev, I SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M r s