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FOR OFFICE USE: ; 01 APPLICATION FOR SANITATION PERMIT --------------------------------- - 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 Distridt- 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 L. �Z�--. r 5f}/Y1 '1- fS CENSUS TRACT S Owner's Name ------ L- O k�- ---n---��-�-�--^---- --------------= Phone Address ----- ------------ t'Z S /Vj"A4iE_(,_S City11 C' .+' D p ---- Phone ? Contractor's Name d F f � �- -- ------------------ --------License# '- f� Installation will serve: Reside nce,,&0A0Partmenit House E] Commercial QTrailer Court i❑ {f, i Motel ❑ __ Other _11------------------1' Number of living units:._._ _ Number of bedrooms - _Garb)a e Grinder�� Lot Size __________ _ ___ ___ ....9 --- 9 /T ca" 1' Water Supply: Public System "and name + - 11 ------------------- ) -- ----------------- rivate ®� Character of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay .❑ Peat ❑ ISandy Loam ❑ Clay Loam ®— I f. �/' : Hardpan E] Adobe:❑ ,ll MFiaterial --/r.L ;J#yes,type ---------------------------- r (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 seepa pit permittedjifl.. ublici sewe4is available within 200 feet,)iPACKAGE TREATMENT [ � ' SEPTIC TANK'[ 5ize__ �lt�___________________________ Liquid Depth _____�__.-------- } ---- Ct Capacity AZ490 Type ��----- _ Material_- _ . Compartments ____ _---- r 0 It . {� Distance to nearest: Well -----�� ____ t_ ________Foundation Q Prop. Line ..J------•---•- C LEACHING LINE [4/"No, of Lines -----_ Length of ea line-___. t- __...____ Total Length ___ Q b ,. ,T r R' i3ox� _ Type Filter Material _ _ _______Depth Filter Material ___ .__.____..............(--___._ Dc/L Distbnce.to nearest: Well U[1 ------- Foundation Foundation Aa.-�r7----- Property Line fir✓_____"_.".__ SEEPAGE PIT [ ] Depth _______ _ __ ___ Diameter--T--- QN'umber ---------__________________ Rock Filled Yes ❑ No �❑ e s Water Table Depth ---------A-----------------t_�_l------------Rock Size -------------------------------- /4 Distance to nearest: Well ___ __________{x: ______________Foundation -------------------- Prop. Line ...................... REPAIRfADDITION(Prev. Sanitation Permit# _______•___ ------ ____________________ Date -------.-----------.-------------- } Septic Tank (Specify Requirements] ------- ---------------------------------------------------- ------------------------------------------------• ---•--- i A Disposal Field (Sp cify Requireme ts) _____ __________________________________________ ?w ----------- ------------- (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 Pules and Regulations of the. San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I cerqthan t .pe or of the work for which this permit is issued, I shalt not employ any person in such manner as to ub ct toiW rkm n' ation laws of California."Signed ' ;�_ ---------------------------------- Owner E ---------- ------- - --- ---------- -- ` ------ Title ----- ----------------------- ------------------------------------------ I€ (If other than:owner) 3 � ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPT= a �-�; I� / BUILDINGPERMIT 15SED�BY'------l-_i&r---""---------------------------------------------------------------------------- DATE ----- -i_Z.- --------- UD -- 1 - - --------------------------------------------------------------------------------DATE -------------------------------- ADDITIONAL COMMENTS----f--------- - -- -------------------------------------------------•-- --------------- - --""- _ . r 4 ,. = ------------------------------------------------ -- ---- -------- - Final Inspection by: -------- -- - --- --- -------- Date ----- ----- N SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M p