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FOR OFFICE USE: v y � - - APPLICATION FOR SANITATION PERMIT Yr: '" (Complete in Triplicate) - Permit No. _ - -- 4--------j -Q______-__ "' This Permit Expires 1 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 madp in compliance with Con Ordinance No. 549 and existing Rules and Regulations: P_ - - .-1 i i� � i. JOB ADDRESS/LO TI N�r � �n_s___ �-�' �4 ►1.Lt. '_ w_CENSUS TRACT Owner's Name ---- --- ---- 1rt_LL # -GZ� z Phone •------ •-------•- -- Address ----- ----�Cl _ ---- �' --� � Y -----_ Cit -------------- --- Contractor's Name _-.License #� --% - --- Installation will serve: Residencb A'p'artment House❑ jommercial❑Trailer Court i❑ e-- _ - Motel ❑Other ------------------------------------ --- Number of living unifs------- __ Number of b room Gar a e tinder _________ t Size $ �' --- .74__: __r ----- Water Supply: Public System and name _______ _____ lvv_�� r - - '-------- ----Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ 'Clay Loam ❑ Hardpan ❑ Adobe ill Material _/� - If�es, 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 seepage pit permitted if blit sewer is available within 200 feet,} PACKAGE TREATMENT V SEPT C TANK'[ ] •� Size-_______ \ {} a]► I Liquid Depth _ /Z \ p� Capacity , T ype __ f� Cr~�1 steric 131_-I. -, .lo. Compartments --- ---- _ ____Distance to nearest: Well ------------:� ----------------Foundations .I Q�____----_E Prop. Line __ "'/f----- '1 LEACHING LINE No. of Lines .;;4�----_ Length of tach line____�,�'______ Total Length ___� ___..____.-_ -' ' 11 Type lr� th Filte Material ___ Ynea T eFilter Material - eDp t-,Distance.frest: Well.r,_-,-__r ,--�,_---_-_Foundation. _ _- _. 'Property Line ------------------------ SEEPAGE PIT [)�' Depth --Y'I__ _ Diameter - --��--- Number .__ ~ _��__ Rock Filled Yes ` Water Table DepthfRock'SSilz'e - - f Distance to nearest: Well L // �^ --------------Foundation _/ _ --- Prop. Line ---Z.-_f REPAIR/ADDITION(Prev. Sanitation Permit# ___#-------------- ------------------------ Date-____-_____._ Septic Tank S ecif Re uirements --- ---- � p Y q 1 - - ' - -------------------------------------------- -----•--------------------------- Disposal Field {Specify Requirements) --------_------------------------ ------------------------ - (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 Rules and Regulations of the Son 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 su ject o Wp rkm�an's Co en)ation lqyvs of California." Signed t- Owner BY --- -------- -- -------- ----------- -------- -- Title �e1 - - - -- --------------------------------- other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY PERMIT ISSUED ------- -- ------- BATE _.��---- -- --- - .---------- - ,r ---r: DATE -- -- ADDITIONAL COMMENTS ! --5----)e-� ------- Cw --------------------- ------- 9-1-d-,- --------------------------------------------- --------------------------- --- - • ------- -- - -------- -- ------ - ------------------------------------------------------------------------------ Final Inspection b p Y: -- � -- - -- -- -f�'-�_'_-� - __ Date --- ----- ----- - -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M