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FOR OFFICE USE: 36 '/ .," APPLICATION FOR SANITATION PERMIT 2y7 --- �-- -- -- -----------------•- Permit No. - -----•- ---...-. . ------------- (Complete in Triplicate) -_------------------_ This Permit Expires 1 Year From Date Issued Date Issued __` _ Application is hereby made to the San Joaquin Local Health District for a per 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 .-- -�_-_ LQ014;L-------------------------- '�_ �+�------CENSUS TRACT --------_--------,-------. Owner's Name I�� ----- ------ --- /!�'� 'i � - ------ --------- Phone ---------- ------- -- - 11 Address -------- _ 1 - --C9,SCG�---------- City �! ' - - - ----------------------------------------------- Contractor's Name -- =_44nh - --------------------------- --------License # -------- --------------- Phone -------------------•--•---..,. - ----------------------- 6 Installation will serve: Residence- pal ent,House❑_Commercial ❑Trailer Court ',❑ Motel Other ---- ------------------------------------ ' I �j Number of living units:--_____ Number of bedrooms 3_-_--Garbage Grinder I----------- Lot Size -`----x-_ _ ./-----_----J_-_- Water Supply: Public System and name - - -- - Private [�]f Character of soil to a depth of 3 feet. Sand'el'-Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ W Hardpan ❑ Adobe E] Fill Material --_--- If yes, type ----------------------- -- .f ` (Plot plan, showing size of lot, location of system in relation to wells; buildings, etc. must be placed on reverse sid .) qkk NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �3 ` `� PACKAGE TREATMENT [ SEPTIC TANK'[ Size_-5'� `��'tis`�`! 14,. _ !--_____-_ Liquid Depth __________________________ Capacity L2__BQ Type"!' - Material: �'_ No. Compartments --�--'_____________ Distance to nearest: Well ---J:��__--_-__-_--___-_---Foundation _- 4_r-_--_--__- Prop. Line �5 _____________ LEACHING LINE [+�]� No, of Lines ___-5------------------ Length of each line......7-------.-_--- Total Length _zl10.l.-_-_---._ 'D' Box _ ._ ------ Type Filter MaterialSj�.�447_4'Depth• Filter Material _L1----------------___._._----__-_-.- Distance to nearest: Well _t5 --____----_-__- FourJdaiori *_ f-__________ Property Line _` ------------------ SEEPAGE PIT [ ] Depth -------------------- Diameter ------W -Number ------ --------;.--------_- Rock Filled Yes ❑ No �] Water Table Depth --------------------------- C1oc S e -------------------------------- Distance to nearest: Well ----------=----------------------4�__Fouridation ------ Prop. Line --------------------- REPAIR/ADDITION(Prev. Sanitation+Permit# -------- - ------- -- Date��t_--_-_-_`----------------____-) Septic Tank (Specify Requirements) -------------------------------------------_ -- Disposal Field (Specify Requirements) ----------------------------------------------------- t -------------------------------_------------------------•----------- 1 / IV -------------------------------------------------------------------- ---------------------------------------------------- ------ -- -- ----------------------------------------- ------------------------ ? ------------------------------------------------------- (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 licen- sed agents signature certifies the following: I--," - "I certify that in the performance of the work for which this permit istissued,.1 shall not employ any person in such manner as to become ubject to Workman's om nsat, n-Jaws-of California"---��- -� E Signed , - -# ----------- ------- Owner BY ----------� ------ Title ---------------- ------------ (If other than owner) I ,- 1 __-_ I POR DEPARTMENT USE ONLY G APPLICATION ACCEPTED BY ---- -- - - -------- --- ------ •------- --- - ----------&------. RATE ----- 1-----uT-----,�--LSI------------- BUILDING PERMIT ISSUED +, ------ _-; --- - _ - DAZE ------ ADDITIONAL COMMENTS ----- ---d � �y -----�✓ry?�- ,.c,�r�7 � Ed_ . -------------------- ------------------------------ -------- - - -- ------ ---- ---- ------------------------------------------------------------- t - - - - ------------------------------------------ -- ----------=------- Inspection by: - - _ ��---- ----------- ------------------------------------------------------------------------------------------------------- Final q -- ------------------------------------------------------------ ---- ---- -- ------------.Date ----- - -'�--i----- ------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT C� E. H. 9 1-'68 Rev. 5M