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FOR OFFICE USE: � 2� .;. TION FOR SANITATION PERMIT ----------- ------------- Permit No. - �r7 ------------------ {Complete�in Triplicate) - ----"/�"" _-_ �_ �_.--___._____.________ This Permit E, ices `Year From batelss d Date Issued I 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 made in complianciCount Ordinance No. 54 and existing Rules and Regulations: JOB At- DRESS/LO TION . �.►/_-�.- - ,ewTr, - -- ----- --- . . _ -""'"CENSUS TRACT ------ ------- *Owner's Name - - --- ----------------------------------- Phone9�X�/ �/--- Address ._._.. �/ r City Contractor's Narzt.,.. . _ ..- Cc License # -� G-3-%` Phone '�� ., � Installation will serve: Residence A artment p House❑ Commercral ❑Trarler Court :E] l f Motel ❑Other -------------------------------------------- _F Number of living units:___!_______ Number of bedrooms -___-__Gdrba r' der _-_ _------- Lot Size /_` _ -- _ � -------------- Water Supply: Public System and name ____ -�P:c�xsrn./ _. ____ _ _t__________________________________Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Si ❑ Clay ❑ Peat❑ Sandy Loam -Q Clay Loam=❑ Hardpan ❑ Adobe X Fill Material If yes, type -------------------_______ a i (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' Siz r r G p -y it � � �-�•=f-----�--- --------------- - Liquid De th ------___�?_-----=------ Capacity8_C�iQ----- -_ Typ �� -aterialgItIt.I.&_ No. Compartments _.- -______________ Distance to nearest: Well �___--------------Foundation ----A0---------- Prop. Line ___.--- .{..._._ LEACHING LINENo. of Lines -40---- Length of each line.___. -___E� q g . --------------- Total Length :---- 1 C- - . 'D' Box ______..--- Type Filter Material __ Depth Filter Material !______________ ______ i -- Distance to nearest: WeIIX.v -___--__ Foun ation --hp- Property Property Line _ --(101"" Distance SEEPAGE PIT Depth e ,� n_-___ Diameter -3-3 Ir` Number _______ _________ Rock Filled Yes No ` ---- f Water Table Depth _-- -----------------------------------Rock Size�c _ l-r�----- Distance to nearest: Well _A_gXl' -_________________Foundatiion0_ - Prop. Line ___-._: I REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ------------------------------__--I Septic Tank (Specify Requirements) -------- --------------- ---------------------------------------------------------------------------------- ------ tr n Disposal Field (Specify Requirements) - - ------------- ----------• --------------------------------------=----------- - -- ------------------•--------------- i 4 ------------------- I -------------- ----------------------------- -------------------------------------------------------------------------------------------------- -i ------------ --- ------ -------- - k----------------------------- ------- ---------------- =---------------------------------------------------------------------------------------------- i {Draw existing and required addition-on reverse side) I hereby certify that I have prepared this application and that the` workjwill be 'done in accordance with San Joaquin „ County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Lacbl Health District. Home owner or licen-. secs agents signature certifies the following: .• 1 "I certify that in the performance of the work for which this permit is issued,_] shall not employ any person in such manner as to be s lett to rkma 's Compens n laws of California." - I BY -------- ------ Title -- ------- (If other than owner) i fi i FOR DEPARTMENT USE ONLY _ s .APPLICATION ACCEPTED BY --------------------- ` --------- ------ ---- DATE ---------------- BUILDING PERMIT ISSUED ----------- ----- ------`------------------- t_= ----=- " ----------DATE ---------------------------------=------- ADDITIONAL COMMENTS --------------I --------------------- ----------------- -- �- -._ - -- ----- -------------- ------- ------ -=---------------------------------------- -------- _-`----- - - --------------------------------------------------- ------------------------------ t 1 ---- ---------- - ------�- - --------------- Final Inspection by: - - ------ ------ - ---- r . --- - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT t . E. H. 9 1-'68 Rev. 5M. '.