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Poo CP S r� �. FOR OFFICE USE: pp�ICATION� SANITATION PERMIT --------------------------------------------------------- ttJJ c� `d �- �- 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 permit to construct and install the work herein described. This application is made in compliance with hhjCounty Ordinance No. 549 and existing Rules and Regulations: 'LfY �``�-i-'�- �' C4------i4T,?P.6_CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION .-_J_A/Y__i/__-�'A� Owner's Name -- © = --------------------------------------------------------------Phone p -35-_-� Z Address ---------1-74-1�----- --.�e'_ _-IRA_�t kQ---------Ak-Q City ,Se9111� Aq-Af'-[2 u Contractor's Name ___ y___4____50w-_-.-__._._-____.License #&6_:7Xel- ---- Phone - Installation will serve: Residence ['Apartment House❑ Commercial [-]Trailer Court ;❑ Motel ❑Other ------------------------------------------- Number of living units:-----/----- Number of bedrooms -----/----Garbage Grinder ___________ Lot Size --_____-__-_-__-- Water Supply: Public System and name -- s-i!_i-/ -------------------------------------------------------------_ ---------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam to Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type._-_-----___--_______-___ a (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 [ ] Size------ ------------ Liquid Depth -----y ............... Capacity P_Q_ Type No. Compartments __;71 ............... Distance to nearest: `f Well -_____________------------------Foundation ----/-0-& Prop. Line .-1b_�___....._ [ ] !___________ Length of each line____-/at1_'r-,_--__-_ Total Length -_/OD LEACHING LINE No. of Lines ________ .............. ` 'D' Box ___________ Type Filter Material --------------------Depth Filter Material __________--_-_-__-----___.__.---.__...-_-. Distance to nearest: Well ------------------------ Foundation __-;RjV------------ Property Line _117-- ... SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes '❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ------------- -------_--_--._.-_ -_--Foundation -------------------- Prop. Line __.-__._---_.-_------ REPAIR/ADDITION(Prev. Sanitation Permit t# ____________________________________________ Date ----------------------------------) SepticTank (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 licen- sed 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 subject to Workman's Compensation laws of California." SignedL3/-------------------------• Owner By --------/ - - -- ------- ------------------------- Title thee aha � _.._ FOR DEPA-RTMLE19T USE ONLY APPLICATION ACCEPTED BY ___________________________________________ _______ ___ _ / = DATE ------- 1_/J~`��----------------- BUILDING PERMIT ISSUED ----------------------------------- ------ -- DATE ------- ------------------ ----------- -- -------------------- - ADDITIONALCOMMENTS --------------------------------------- ----- - -----------_------- ---------------------------------------------=-----------------_-------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ------- ------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- --------------=------- Final Inspection b - Date ---- / i -� ------- Final Y: --------------- SAN JOAQUIN LOCAL HEALTH DIST ICT C ti's' E. H. 9 1-'68 Rev. 5M