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FOR OFFICE USE: -;— ` . - ------------------- IM APPLICATION FOR SANITATION PERMIT I` (Complete in Triplicate) Permit No: ------------------------------- - ` ---------- Date Issued This Permit Expires f Year From 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION LOCATION .--�- t R _P0_(\/__CENSUS TRACT K Owner's Name __e P.-i�- - / fY° f_��- ------------------------------------ -------------------Phone sJ _ Address ' .......... Contractor's Name __-" - Jew , -/r/"� Cirv - + - ----------------------------------------- ---------- Y/ -----------------=--- - 'G /- -=--- ----License #2-YC ?1 _ it Phone -" Installation will serve: Residence Apartment House,❑ Commercial:❑Trailer Court '❑ Motel ❑Other Number of living units:- Number of bedrooms __-_-_Garbage Grinder N - Lot Size - =_--_-_ Water Supply.,I Public System and name --_-_-- -_- --------------------- Private Character of soil to a depth of 3 feet: Sand'i�llt❑ Gay ❑ Peat❑ Sandy Loam •❑ - Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] v / NEW INSTALLATION: [No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK' Af �t1 [ 1 Size -----•-�P--X--- _--------- Liquid Depth ._7-_a---------------- Capacity 410-6---- Type -------------------- Material---------------------- No. Compartments sr,--_- Distance to nearest: Well ---___-- i ------.Foundation __/Q------------- Prop. Line __i57 ------------ ( J Noof Line _.-.Z---------------- Length of each line----- -- ----__.--.--_ Total Length `t�� LEACHING LIN . s ---�-�--♦------••---"--- 'D' Box/E�5 Type Filter Material _-R601t-Depth Filter Material ---/ ---- Distance to nearest: Well ------------��Depth ------------- Foundation ----------------/0 Property Line SEEPAGE PIT --___- Diameter _--_--_--_-_--- Number ____-.------- ---------- Rock Filled Yes [I No i❑ �[ ] Water Table Depth Rock Size ----- - - Distance to nearest: Well --------------------------- -------- Foundation -------------------- Prop. Line --------------.- _ ' --•- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------- ------ Date ----------------='-------•----_-_-} Septic Tank (Specify Requirements) ---------------------------------------- -------------------- ---------------------------- Disposal Field (Specify Requirements) -----------` i �(_1��7-hlG �/�"— f -------- A--, l� 7 3n ----------til_1Tt-!_-----c'om----------&{F!' 'S7� l�j�,. - / --- ------------------------------------------ .(:Draw existing and required addition on reverse side) ,- _�. I hereby certifyi.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: "1 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 subiect to Workman's Compensation laws of California." Signed ---------------�- -- _ Owner - ---------- ----------------- --- - - ---------------------------------- ----- BY - ------- ------------------ Title = , 0 (If,other than own FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -C�- ----------------------------------------- ------------------ - . DATE ------BUILDING PERMIT ISSUED = --- - DATEADDITIONAL COMMENTS _-"_ ----- ------------ ---------------------------- ---------- ------ --------------- ---------- ----------------------------------------- - -- ---- -- - ------- ------------------------- -------------------------- - -- --- --- -- - -- - - h---------- -------- ------r----- -- ---- ---- - --------- ------------------- ----------------------------------- ---------------------------- - i -------------------------- Final --------- r ------ Final Ins ectionb ---------------- ------------- ----- Date SAN JOAQUIN LOCAL. HEALTH DISTRICT E. H. 9 i-'68 Rev. 5M 1 .Ih '