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A FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT {Comp#ete in Triplicate) Permit No. .7 '. _Z. ---- ------- ------ ------ --• :..__._......... _ _ ... F ...-•-•............................... This Permit Expires II Year Prem Date issued Date Issued . . .. . Application is hereby made to the San Joaquin Local Health District for a permit to constru4 and Instal[ the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 3�. ... -. ..:............. ...... CENSUS TRACT -vim ..... Owner's Name`. . [.4�.:... �1i LR rtr . ... :...................................................:.............. one ..� ..( ��.,- Address `�' .. ._ .."-.....Lu - ................. ....•-.... City .....:. ..trz �,e.. ..[s....:.. ........ - rr r ........... .......... Contractor's Name ... 12__� � L:. License # s�.0,5_ i�./....... Phone .3.611- Installation 3.6�.. ��... �'tt ....-•• Installation will serve: Residence M-Apartment Housefl Commercial ❑Trailer Court C] Motel ❑Other ------...................................... Number of living units:............ Number of bedrooms Ga a e Grinder ............ Lot Size ........._.................................. Water Supply, Public System and name _. pp y ......................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Sil Clay ❑ Peat❑ Sandy Loam 0 Clay Loam Hardpan p Adobe❑ 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 seeps a pit permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TAMC Si--._r .`J4-1,.., -/— /0.'.4 . Liquid Depth -- j�_...._-- Copacity1�� Type . / -_--. Material..� ,.t_._ .... No. Compartments ................ --I Distance to nearest-. Well --------- +...................Foundation ....iA.1.......... Prop. Line ...��............ � No. of Lines _..� .............. Length of each line... Q �._. .. f. Total Length .J o .. . ............ LEACHING LINE [+� 'D' Box .,�. .- Type Filter Material ..LVf,?-.Depth .Filter Material ... .. ........ -----------------•-... Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT Z4,- Depth Z? -.r....... Diameter ---= 3...f Number -----.�................ Rock Filled Yes M---/No 0 Water Table Depth ...__7V....................................Rock Size ............................... Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... 7 REPAIR/ADDITION(Prev. Sanitation Permit# .-.-.....-....-----------------.-- ......... Daae ..................................I . Septic Tank (Specify Requirements). ------------ -•-••-...-----....•-•-•._....__ ...... - .............. Disposal Field (Specify Requirements) ............. -----------------------------•------ ...----------------------------- —.......-•-----•-•-- ...........................------ ...................I............................ (Draw existing and required addition on reverse side) I hereby certify that 1 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. Horne owner or licen. sect agents signature certifies the following- "[ 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 ------------ ---- --- Owner J By -�--- ---- -- - Jitle _.. 'b°�r(..-.._- L�,.. r✓f I other than ownerl EP RTMENT USE ONLY APPLICATION ACCEPTED BY ........... :.;: DATE ...../7`�. BUILDING PERMIT ISSUED ----------•------------------------------------•-••---- DATE -..---------.-............................ ADDITIQNALCOMMENTS ------------------------......--..........--........ .............................................. ...................-------•----------••--------- ----- -------- ------•----- -....__..._..._...----------------------------•----......---••---..-..-------------- - ----------------------------------------•-•-----------... . . . . Final Inspection by -. :- ems....-.----• Date ... ... �" ;.7 EH 13 2h 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M