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FOR OFFICE USE: APPLICATION FbIt' SANITATION PERMIT (Complete in Triplicate) Permit No. _6 ___-7 _ __ ---------------------------------------------- This Permit Expires ] 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .__hat 412, CEN SRACT -------- ------------- Owner's Name { - n--------------------------------------------------------------------------------Phone Address �f �� Ad— LA_Fl�_ City ! ----------------------------•- '/� - Contractor's Name _,____-_ �-=_____-4l -//-� License#a4_�_/ ptJ� � ' 7 -- -------- hone --------------- r Installation will serve: Residence [Rg Apartment House-[] Commercial❑Trailer Court i❑ Motel ❑Other kNumber of living units:------------ Number of bedrooms ---Garbage G•rincler _ ',Lot Size _-_-••--- Water Supply: Public System and name --------_------------------------- "^ ' T: " Private Character of soil to a depth of 3 feet: SanflZ Silt❑ Clay ❑ Peat❑ Sandy Loam ,❑ Clay Loam :d Hardpan-E]--Adobe ❑==Fill-MaterialTvQ� If'yesi-type—�_______________ � - -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) a: NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewerpi availabl�within 200 feet,) o. r y r� PACKAGE TREATMENT- [ ] SEPTIC TANK'[ 4 SizeJ�- D. _ uid De th __r � _________� meq pCapacity /_ ?-G4Type,- terial-- Y1 ___ CNo. Compartments tante to nearest: Well r,____ __ ____________-__Foun1.dati ______.___ Pro Line ___.�_ P- l-------:--- ,Lines __�__---_-____ Length of each line--__:_��_____________ Total Length ,_ 1 -- Q LEACHING LINE Na, of ,p J_- D' Box! def Type Filter Material ___De th Filter Material ---/J_,` __ _ �- Distance'to nearest: Well _______ Foundation ______1_- --r,- _, Property line _lam'- _____________ SEEPAGE PIT ( ] Depth _°__________________ Diameter ,.:____-_-___ Number -----------------.---------- Rock Filled Yes ❑ No I❑ ( Water Table Depth p ------------------------- Rock Size Distance to riearest:.Well.--_=_--�----------------•------------Foundation __------------------ Prop. Line --------______----__ REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------- Date SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------------------------------------- Disposal ---------- ---------------------------------------------------------------------------- Disposal Field (Specify'Requirements) ----------------------------- --------- ----------------------------------- - -- ----- --- - --------=-------------------- ----------- h -------------------------------- -- ----- --------------------- - ---------- ----- �-- - r (Draw existing diid requiredaddifion`on reverse`side) ^ I herebycertify that I have fl+ ,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 Lokal 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, t shall not employ any person in such rafter as to becom subje t to W rkmari's Co nsation laws of California." J Y ` Signed -- - ---- ------ �-------------------------- ------ -- Owner By ------------------ ----------- --- --- (If other than owner) , a FOR DEPAitT ENT USE ONLY APPLICATION ACCEPTED BY �� i-- ---- ------------------------------------------------------ ------_ DATE _ r BUILDING PERMIT ISSUED ----- ----------------------- -- �, ------------------ `------DATE -----_= ADDITIONAL COMMEN _. - ----------------------- -------- ----- ---- -- R�- SAN--JOAQUIN' - _--- -- ---- --- ----- - -- --------------------- ------------------------------------------------------ ------------ ------- -------------- ----------------------- - Fina ns ection b - _ '_ ----- - - bat �" f - a e /-- -,- �;--- - --- -- - --------- LOCAL HEALTH DISTRICT-- - E. H. 9 1-'68 Rev. 5M, 4