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FOR OFFICE USE: FOR OFFICt USt: ,r APPLICATION FOR SANITATION PERMIT ' Y .S 60 (Complete in Triplicate) Permit No..� ----... Date lssued.7: (_?-- ................ .........._._._--_..._......... 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 application is made in complionce.with County Ordinance No. 549 dnd existing Rules and Regulations: JOB ADDRESS/LOCATI ---- /� d ......CENSUS TRACT---------- -- .......... ON....1�./�`�-�. � - ---- ----- -- - --- --lr-P�- - --------- D1. . _!'�. Owner's Name.... .,4.ASD-� ------------Phone .93�-.�_SS-�........... Address �.� -93---- Il ...Ael..... r..... City----.. -VJ----- -------- ._Zip--!S.,-Lap......... Contractor's Name__-.,<9..x_"... ..License #-- ....Phone.3.d67lo.7-.._.._. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other----- Wd Y -.- Number of living units:-----�-------Number of bedrooms--. Garbage Grindar-Ve-'.-,-Lot Size------- ---------------- Water Supply: Public System and name.. ......................................... ---------------........... .......----------------------Private Character of soil to a depth of 3 feet: Sand ❑ Slit ❑ Clay ❑ Peat ❑ Sandy Loam [❑ Clay Loam ❑ Hardpan Adobe ❑ Fill Material . .... ....lf 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,} . e� PACKAGE TREATMENT [ } SEPTIC TANK Do Size -------- .--------------------------Liquid Depth..----------------- Capocity_-i .__p-=....Type._ __ O_-a r.I.S7�'Mate-rial_-�,tl .... O P� No. Compartments. -Distance to nearest: We1L-..--./a9.......... .... ..... ...Foundation_.._�D. __... . Prep. Line_._.�.-�"--..-.--...- i LEACHING LINE [)o No. of Lin-es ..�------- ...- .Length--cf-each�liinee..�._ ...__..__...__Total Length . ----------- ----------- D' Box----/._....Type Filter Material.� .�-Z `'Depth Filter Material__ ._-/..9- --. ---------.r... ------ Distance•to nearest: Well--_.. .........Foundation....�� f'_--....---.Property Line_..__--�........-..... SEEPAGE PIT j)(J Depth---r ,�_�.Diameter_._ ._. _..Number. --------------------- Rock Filled Yes No ❑ Water Table Depth......._.0Q _. Rock Size_.y_�y---.--l�fA• �1� Distance to nearest: Well.___-. 80_ _______________________Foundation Prop. Line.--S__._.......__..... REPAIR/ADDITION (Prev. Sanitation Permit#----------------------------------- ...............Date-------/------------ ------- ----------.. } Septic Tank (Specify Requirements►...... ............. --------------------- ......-- .......... Disposal field (Specify Requirements). .. ----------- ------ ------------------•-------------------------------- .............. -------- ------------ --------------------------------- ................. -- ---------------------------------------------------- ........ .........._......... ------ (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 District. Home owner or licensed 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 ub�t to orkman's C m ensation laws of California." Signed '�+.. JA G. Owner 3- By.. - Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- .... ......... . ---...DATE ----- DIVISION - 7DIVISION OF LAND NUMBER--- ----------- --- .. --DATE..-.............. ------ ............. ADDITIONAL COMMENTS.................... - ---------------------------- --------------------------------- -_---...--- - ---... ._.....- ---•.......... ..........I ............. .................... ---- .................................................. ------------ ------- I... ------------------ --- -- - --------------- --- ------ ---.---- ------ --------• .............. ----•------------- -•-•----- ----------.......... .. - -------------------------------- -- - /'j 7 � .Date. -. .�../../- res 2i 6�7 xsv Final Inspection by:....-.---... -.... ... -- ----- FH 13 24 SAN JOAQUIN,LQCAL HEALTH DISTRICT . 7/76 3M