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__�r � of/Y" •.d FOR (OFFICE USE: APPLICATION AOR SANITATION PERMIT Permit No. .�-••• ........ -- - --- -------------- --•----- ••- •• - ! (Complete in Triplicate .. ..,......- =------------------------- - + ............E .! Expires date issued �-.. __. This Permit xpres 1 Year-From Dat!issuad f 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION Jo-h-cl.A/.[-Rd—./•©.M. .J..... USUS TRACT .......................... .....Phone,36f.R74..,�........ Owner's Nappme .�E 11! V C' S'..._......:- Address ... ! - - ......-.....__ �........_.. City .................... . ....... 1 lr83 85� Contractor's Name .0� �:(�P��.e.,JV.- :.... 4f/..�f/Q//......License #' ........................ Phone ..............-......... . I Installation will serve: Residence)N(Aportment House 0 Commercial [Trailer Court ❑ Motel 0 Other Number of living units•----1 Number of bedrooms Garbage Grinder ....I....... Lot Size ............................................ Supply,: Public System ark! name Private; Character of soil to a depth of 3 feet: Sand.0 „Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loom Hardpono Adobe 0 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: lNo septic tank or seepage,pit :permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT l ] SEPTIC TANKA] Size---------... Q................... Liquid Depth .........?'.............. ' Capacity/A%0 0---.---•- Type(�tr� .. Material--- No. Compartments ... '...-•-........ Distance. to nearest: Weil .�.J- ---- ---------------Foundation ------ . .. _ Prop. Line ...................... LEACHING LINE ( j No. of Lines ..._._ Length of each line. 5..:................. Total length /• 'D' Box ....----.... Type Filter Material -------------------Depth Filter P aterial ......._............--•--.........-...... :.: � Distance to nearest: Well -f��-fir.......... Foundation ..--...1t. Property Line ............ ........... / .... Rock Filled Yes No SEEPAGE PIT: [ j Depth - --------- Diameter .............. Number .... j Water Table Depth --------•---------------------_ ...............Rock Size • ................... �. t Distance to nearest: Well 1. ......................•----Foundation ...... Prop. Line ...................... i REPAIR/ADDlT10N(Prev. Sanitation Permit#' ........................:................... Dale ----•----------------...........--) - Septic Tank {Specify Requirements) ----------------------------------------------------------------------------- ------............................ ........................... 9' i • Disposal Field (Specify Requirements) ----------------- ----------------------------------------------------------.....................-....................------ ------------------------ ------ ---------•---------------------------•- I ............... ----------------------------------------------- ................... :I i (Draw existing and required addition on reverse side) r 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 far"which this permit is issued, I %half not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signe ---- ------------------•-----•-•------ ------ -• --- Owner Yitle I (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------- --. DATE BUILDING PERMIT ISSUED ---- ----•-- DATE ADDITIONAL -:- ADDITIONAL COMMENTS�Q -clr- . ... ..- �d xS"•f ._.. _ - ... .. . 24a �0 Q ... ------ •----------------- .. ---- ----------- ------- -- --�. - / -_... . - .. ..................=--- ------------- -- -------••------•------•----•-------------•--------- ------ ----------- ............-.-.....::..j1. a s: .................... Final Inspection by: .........�.� .......... ------------- - -----------•--•-••-----------•-• ........... ...Date .. EH 13 2h 1-68 11ev• 5M• SAN JOAQUIN 'LOCAL HEALTH DISTRICT 8/71 3M