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FOR OFFICE USE: APPLICATION FOR SANK ATION PIERIT Permit"No. -------AA_-------- "" (Complete in Triplicate) - --------------------------------- Date Issued ----------------- - __ __ __ _ This Permit Expires 1 Year From bate Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein application is made in com liance with County Ordinance No. 549 and existingRules and Regulations: g described. This app ' P - CENSUS TRACT ----- --------- JOB ADDRESS/LOCATION - '�-- �--� '=- p- Phone -----------`----- Owner's Name -- CSC- -------------- /" City nC 1C_!__5 � ------ -------- Address � 9f�= ----------------------------------------------------- c� Contractor's Name .1� -r----- t� -------------------- License # Phane` _'-��' � 'i installation will serve: Residence �-Apartment House❑ Commercial ❑Trailer Court °,❑ 1. Motel ❑Other ------------------------:------------------- Number of living units:-- -/--- - Number of bedrooms __3-----Garbage Grinder Lot Size �7------------------ ----- _ Private + ❑ 4 Water Supply: Public System and f name -------------------------------------------------------------------------------------------------------- Character of soil to a depth of 3 fleet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam E] Clay Loam ❑ I —Fill Material ------------ if Yes, type ---------------------------- Hardpan F1 Adobe'[4 I I (Plat 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 240 feet,) / �. ' PACKAGE TREATMENT [ I SEPTIC TANK'[ Sizer ------------------- Liquid Depth --�----------•---.---- Capacity ,��-�--- -- TYpe��_��-_ Mater9ai-+�Ct/_�C�f�t No. Compartments � --------•=-----:.... � Distance' to nearest: Well -____1-�-----------------------Foundation --------- ------ Prop. Line Length of each line_ - -f------- - Total Length --- s1- ....... I LEACHING LINE [t]" No. of Lines ------------------------ 9 Gal-- --___Depth Filter Material --/,47_ - " " 'D' BoxX, -" Type Filter Material E F U f--------- Property Line. --- ---------- _- Foundation -___ ._ , Distance to nearest. Well "" �-------- Rock Filled Yes ( No .O SEEPAGE PIT [��'" Depth 11---- Diameter _ �� --- Number 4--------,-- t Water Table Depth ---- �----------------------------------Rock Size .._ -I ------------ } Distance to nearest: Well --- -G�CJ--/--------------------••-Foundation _C�___ ---._ Prop. Line _.. ---------- i REPAIR/ADDITION(Prev. Sanitation Permit# """---- --------------- Date --------------------------- ------} .;1 ----------------------- Septic Tank (Specify Requirements) _ __""__--- - ------ ------------------------------------ f Disposal Field Specify Requirements) ------------ - --•---------------- ------- --------- " ------------ -------------------------------------------------- ----------- ---------------------------------------------------------- ------------- ------------ ------------------- J -- ---- -- - - - - - ------------- --- - --�" -�" ,;� (Draw existing and required addition on reverse side rk will be done I hereby certify that I have prepared this application and that the woIaccordance with San Joaquin t County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homeowner or licen- sed agents signature certifies the following: rk for which this permit is issued, 1 shall not employ any person in such manner "1 certify that in the performance of the wo as to becom subjec �Wor man's Compensation laws of California." l ----------------------- ______-___- Owner Vr7``_-_ Signed _ --- -s:•- -- --- -------- VT --------------------------------------- Title - ------- ------------------------------------------------- ------------ hf other than ow�n ed F RTMENT USE ONLY DATE /C?-^_ �,p APPLICATION ACCEPTED BY ------- " _ ------ -------- -----=-- ------- --DAT ------ ------------------------------------ BUILDING PERMIT ISSUED ---ti-------- - - --- ---- --- ADDITIONAL COMMENTS ---- --------- ------- ------------------- -7� .�7 ?C -------- - ---------------------------------------------------------------- ------------------------------------------------ ---------- -------- ------ ! � ----- ------------------------------------------------------ --- ----- a-3` ------- ------------------------------ to _.. Final Inspection by: SA JOAQUIN LOCAL HEALTH DISTRICT + E. H. 9 1-'68 Rev. 5M. ,,�,