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FOR OFFICE USE: .1 L_o#w: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) ------=--=---------------------------------------------- Date issued --------------- t This Permit Expires 1 Year From 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 applicati is made in o pliance with County Ordinance No. 549 anc�o /� g and Regulations:r)ng �P bCfA ` Y�5 .c` L. JOB ADDRESS/LOCATI S QF IJ P-•�_---_Q� ��/�.�-------------CENSUS TRACT '�7Z---------- --— Owners Name / Y/ o /�_ --- ---------------Phone f� �---- -0Xr��50A1----------- ------ -- - -- - = ------------- f / CityDGt�' / --- ----------------------------- ---------- AN Lt Address ---- --�- - ------- �l!-d�/ ._-----�//� -------- Contractor'% Name --�lr ----� �� ----� ��;----------------------=--------License # 112--7593-- Phone installation will serve: Residence 5Q Apartment Nouse❑ Commercial .❑Trailer Court l❑ Motel ❑Other------------ ----:------ - ---------------- Number of living units:.--/---___ Number of bedrooms __3---___Garbage Grinder __ Lot Size - E Water Supply: Public System and name ------------------- -----------------------•----------------------_.---____--Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay-Loam ❑ 4 Hardpan -. Adobe ❑ Fill Material -.---------- if yes,type ---------------- ---- - . P ❑ - (Prot 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,} t A PACKAGE TREATMENT [ } SEPTIC TANK Size_— --:�t� ,lr�-------------- ---- Liquid Depth -�__-------.-----.----. Ca acit I� LT e L ice- ^Material lwl �_ N-o• Compartments __171________________ P y ��- ---a YP � r / a Distance to nearest: Well _ __--_Foundation _ �__ ___________ Prop. Line J _.______------- LEACHING LINE [ No. of Lines _02----------------- Length of each line_..1.4 0--`--------- Total Length .--,;21X _------------ 'D' -- .__---•-'D' Box _ Type Filter Material 1,P ----- Filter Material ___ ------------------------------ Distance to nearest: Well _ Q--�-- ----- Foundation _r----------- Property Line _--_____________ it SEEPAGE PIT � Depth _-_ gs-/-- --- Diameter IV--------- Number __._ _______ _______ ___ Rock Filled Yes No r Water Table Depth -IS --------------------------------Rock Size -1� _ � i Distance to nearest: Well _/1 -----------------------------Foundation _IV---------- Prop. Line ...... —---------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------"---------------- ----- Date --------------- -----} Septic Tank (Specify Requirements) ----------------- ------------------------- ---•---------------------.------------------------------ Disposal --------------------- ------Disposal Field (Specify Requirements) _-________-_ ------------------------------ j ----------------- --------------------------------------------------------- ----------------------------------- ------- ----------I--------------------------------------- (Draw ------------------------------ ------- (Draw existing and required addition on reverse si e) — I V 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 subjeco Work n' Co ensation laws of California." Signed --------------- - `---------G_��-' --�- ---- ---- - ------------------------------ Owner BY ------------= --------------------- --- --------------------------------------------------- Title ------ ---------------------- -- ------------------------------------- i (If other than owner) [ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -------- ------------------------------------------- ----- DATE - r-7 ---------------------- BUILDING PERMIT ISSUED ` `---=------ ------DATE -------------•----------------------=- �' ADDITIONAL COMMENTS ------------------ --- ----------------------- ----------- - -- ----- - ----- - ---------- - -------------- ------------------ -------------C-------- -- ----------- Final Inspection by: 7 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.