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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _-7-3--�9 ------------------------------------------------�-- (Complete in Triplicate) p Date Issued _`I d_-_'J3 �! This Permit Expires 1 Year From Date Issued Application is hereby made Ito 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: ��✓" &V - x ---- ------- - CENSUS TRACT_�C,' ---------- �. JOB ADDRESS/LOCA N- k_ 1 Phone Name — ---- t--- ----= - -------------------------- Owner's , Address -- Y City License # -�Q .S ---- Phone ---------------------- ------ Contractor's Name ---- t -------- ---- ------ - ----- ---- ---- i Installation will serve: Residence Apartment House❑ Commercial Trailer Court ❑ Motel ❑Other ------------------------------------------- Number of living units------- ---- Number Number of bedrooms __a-----Garbage Grinder ------------ Lot Size �-- Water Supply: Public System and name ------------------____ __ Private ---------- Character of soil to a depth orf 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe'❑ Fill Material -------.---- if yes, type ---------------------------- [ I {plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] N�� NEW INSTALLATION: [No septic tank or seepage pit permitted if vblic sewer is available within 200 feet,] N t� ! 'L ,r �/ X ```� Li u;d De th -T------------ . 0. PACKAGE TREATMENT { ]:� SEPTIC 7AN1<'{� maize-� -'�-'-----/`•••--�----------• q p QI __,P ..- Capacity _ -_--_-- Type ___________ _ ___ Material_--_ '� No. Compartments � '� Foundation ------- -- -----'Prop. Line -------------------- 10 -------to ne rest: Well --_.---____.5�---------------- �i LEACHING LINE [ Nolof Lines ------3------ _----- Length of each line-------- Total Length ---- i D'�Box __Type Filter Material g__��__ Depth Filter Material _--_ _7_______________________�__...__._ 1I. Q--{--------- Property Line -------`f- ---------• -- Distance to nearest: Well __------A-1------ Foundation ______ - l Rock Filled Yes No i❑. �� { c� � r - Number - E SEEPAGE PIT ] Depth ----Q ________--- Diameter ___---_-• --- l il. t -------Rock Size -------------------- --------------- � --------- --- Water Table Depth --------------�-� -------------•---=- � t ------ Distance to nearest: WQIi -- z,- - - ----------------Foundation --------t-,-P------- Prop. Line ---------------••----- i '- ----- Date ----------•-------- �REPAIpR/ADDITION(Prev,(PryvSanitation Permit# ----------- ------•---------------------------------------------------------------_------ ------------ -------�-- --------------------•---- � •Se tic Tank [SpecifeCRequirements)Ruiements] ----------------------------------------------------------- Disposal Field (Specify q ----------- } . �� ----- - (Draw existing and required addition on reverse side] i 1 hereby certify that I have pThis's'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:: l "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 subject to Workrna 's Compensation laws of California." Signed -----� -------- Owner Owner—-- tie ..... ---- ----------f�- - -------- - y -------- -- -------- -- - � --- -- ------ -Title --- I ---: _ [If other than owner] II01 FOR .DEPARTMENT USE_,ONLY ` == - i APPLICATION ACCEPTED h�BY ��-1��z -------------------�-----------�-------------=-- DATE _Y [ BUILDING PERMIT ISSUED-------------------------- •------------------------ DATE ---------------- ADDITIONALCOMMENTS--------------------- ---------- ----------------------------------------------------------------------------------------------- ---------- --- ---- ------------ ----------------------------------------------------------------------------- - -------------- !. ------------------------------- ------------------- --------•- ----------- ------ --------------------- u ----------------------------------- - I ---- ------------------------------------------ Date ------ Final Inspection bY. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5Mi