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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT I Permit No: -- ----------- -------------------- ------------------------' ---------------- (Complete in Triplicate) --------------------------------------------------- -- ---- P - Date Issued -�7___7/_. This Permit Expires 1 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: c .-------- �' I�--`--•---- 4 .CENSUS TRACT .---------� -- JOB ADDRESS/L2�_ TION Owner's Name ------------ --l- �� ---(-!--'-�--------`--"- -------------- ---------------------------- - - --Phone ------------ --------------- .__114 ---------•---- 2 4 /I t ' city �------------------------------------------------------- Address -- Contractor's Name - R. h --------------------------------------------------z--------License #AS5- ?7_---- Phone ----------------------- Installation will serve: Residence ❑ Apartment Housse❑ Commercial❑Trailer Court ;❑ I Motel Ep,6ther _-;5 r/?0 �c - --------------- Number of living units_____________ Number of bedrooms _________...Garbage Grinder ___________ Lot Size ____________.___________________.__ ------ Water Supply: Public System and name ------------------------ ----- ----_--------------------------- ---•.-Private Character-of soil-to-a depth of 3 feet: Sand'❑ Silt❑ .Clay ❑ Peat❑ 5a�5d}�"[oam❑ 'loam"❑ Hardpan ❑ Adobe Rr Fill Material ------------ If yes, type ---------------------------- (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 seep a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK Size-.l`G,X 66X_.__1 ----------------- Liquid Depth ---:?a---- f Capacity _ 2Dll-------- TYp Qr-09---- Material_ r�f�-- No. Compartments ----- ----•------- Distance to nearest: Well ----70 ---------------_--------Foundation _3 ------------- Prop. Line --- --------------- LEACHING LINE [�o. of Lines ------------------------ Length of each lirEe____-�ll�_-___-.._ -- Total Length :_!✓v - ..--------- "V 4 'D' Box Wo------- Type Filter Waterials-9-p/u c Depth Filter Material ---------------------------------------- ` Distance to nearest: Well --- -_70_r__ Foundation ------50........... Property Line. ----------______________ 'X(fl__---- Number ______.___ -- Rock Filled Yes �No SEEPAGE-PI-T- [ ] Depth ----dam__----- -- Diameter _ :_ _ ; ,�----------- � - a Water Table Depths i ' __-=_ _=_ =_____Rock Size -------------------------------- stance to st: We ...(,Q -------------- --------Foundation 3�------- ---- Prop. Line -------•-------------- REPAIR/ADDITION(Prev. Slanitation Pemi+t# .------.---- ` Date ----------------------------------1 -------------- Tank (Specify Requirements) -----------'':� -------------------------p :,._ ,-------_-------------- .Septic Disposal Field (Specify Requirements) -------- --- ` ---------------------------------•--------------- } ------------------------------------------- ---------- : -------------------------------------=----------------- ------- _ ---------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------------ 1 (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 f 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 Wor an' Compensation laws of California." Owner Signed ..... - BY ------------ ---- -------------- ---- - Title --- ------------------------------------ - . - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- `� DATE __fes- � �------------------------ FBUILDING PERMIT ISSUED _:__::__- ------. ------ ---` --- -- — _==--t� -t�= ---DATE--. f' ADDITIONAL COMMENTS ----------- __ l / .� 6.r1 .[ ---l- -- ----- --- -------------- �- - DC7— ------- ---� V I - - ------ --------- ----- - ----- F t71R / bc_ �SQ /� - -- ------ ----------- -------------------------------------- -------- ----- ---------------- , ^� ------------Date ---- -----------� -- ---Fi nal Inspectio \-- ------ - - - - SAN JOAQUIN LOCAL HEALTH DISTRICT G u a t_'AR RPv- W