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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y f Permit No. -71+-r'� Z (Complete in Triplicate) �---- Date Issued -- ------------------------------- ----------- fOr/ This Permit Expires 1 Year From bate Issued ------------ Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �Q --CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION ---;z ,�-J-7' ` " 's Name Phone.---n------------- Owner A p ----- ------------------------------------------------ Addresse� fl '---J City / Contractor's Name -------- -- JL'cr� License # .S'" - Phone Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court l[] fMotel ❑Other -------------------------------------------- . Number of living units ---- Number of bedrooms ___a1-----Garba �'► ge Grinder - V'V1ZLot Size -1 _St_ ---Private Water Supply: Public System and name --------------- - --------------------------------------- ---------------------------------------- Character Private , Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam .E] Clay Loam ❑ Hardpan ❑ Adobe 1% 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 seepage pit permitted if public sewer is available within 200 feet,] r/. (R PACKAGE TREATMENT [ SEPTIC TANK Size--- .x "L '_ , ---------------- Liquid Depth -----'Y -------------- �' Material__ _Q�& No. Compartments ___i-_--.-----<---- Capacity _J;2_0_4! -- Type � --- - - ff ----------Foundation _._107-r�_-----__ Pro Line ----�1 N1 Distance to nearest: Well h_a--- ---- --- p' 4 IF LEACHING LINE No. of Lines ____ ----------- Length of each line- --------------- Total Lengtth ------------------ --- i 'D' Box -__ Type Filter Material ____} �"C'-__Depth Filter Material _____1/ ,____-_______________________ _ Property Line -------------- -------- Distance to nearest: Well _._ s?___"- ---- Foundation _______________"_____-_ p ty -- f'y ___ Rock filled YesJ No SEEPAGE PIT [ � Depth -o2J `" Diameter _ a________ Number __.------ - Water Table Depth ----------------------------------------------- Rock Size ---- ----------•-------- Distance to nearest: Well _____��-__19�r-------------Foundation ____�_0 -- Prop. Line _.-..------- REPAIR/ADDITION(Prev. Sanitation Permit r# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ------------------- ---------------------..__:----------------------------- 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 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, 1 shall not employ any person in such manner. as to become subject to Workman's Compensation laws of California." Signed ----------- ------------------------- ---------------- --------------------------------------- Owner By .. -------------- Title ------------- -------------- --------------------------------------- lf other t an o her FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ __ ___ /� ~7 """"" """" - DATE --- ---- BUILDING PERMIT ISSUED --------------- DATE -------------- ADDITIONALCOMMENTS ----------------------------------------------------- ---------- ------------- ----------------------------- ------------ ---------------- ------------------- ----------------------------------------------------------------"--•----------- -------------- -- ---- ----------------------------------------------------------------------------------------------------- -- -------------------------- ----- �7 Final Inspection by: ______ _ Dat-�� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M