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FOR OFFICE USE. --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT i _________________-__ (Com letein Tr'plicate) Permit No, ---------- -------------------- -' p Date Issued -------------------- This Permit Expires ] Year From Date Issued Application is'hereby made to th.e San Joaquin Local Health District fora permit to construct n described. This application is mdde in compliance with County Ordinance o. 549 and existing Rulestalndt Regulationse work �em ou JOB ADDRESS/LOCATION -----f�'l CENSUS TRACT _.-- `S+ __ Owner's Name 1ZS - _ -- �_- f�y9 - -------------- ----- '` _ Phone Address -1-20--U ✓/ �� - 1 -----f� -----------• ity Contractor's Name Name 3 -------------f----------- -- ePhone - �_---------- Installation will serve: Residence EX Apartment House❑ Commercial ❑Trailer Court -r t Motel ❑Other ------ ---------------------------------- Number ---- -- 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❑ Sandy Loam ❑ Clay LoamE]- -0 - I - r ` Hardpan ❑ Adobe.0 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 flank or �SeeXpapit permitted if public sewer is availab!► e within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK� -' Size--- --��'-_�C/--a--------- Liquid Depth Capacity`�/ ---- Type - ----- --- Material i �`No. Compartments ---------.- - ------=---- 0 istance to nearest: Well _-- cS"�t------------------Foundbtion _'_- - ---f- Prop. Line -- LEACHING LINE No. of Lines ----- ---------- _ r: 4 �Lerigth of each lin ' ---- --}----- Total Length -- 1 _=%'" �_.. F D' Box .-- -_ T e Filter Material ( -4 Yp --__ ---__-_T-Depth Filter Material ----�.� Distance to ne rest: Well ------ ------- Foundation -_1- --______ Pro erty Eine -- ' SEEPAGE PIT [ ] Depth -! -----_ Diameter - ----- Number ------ Roc Filled Yes No ----------- Water Tab Ile _j pth ------------------------------------------------Rock Size -----:---------_--- bistance to ne st: Well ----------------- -------------Foundation --------------- Prop. Line -------------_------ REPAIR/ADDITION(Prev. Sanitation)Pe i # ------------------------------------ ------- Date -------- ----------. - ------- - f Septic Tank (Specify Requirements) -- ---------------------------- Disposal Field (Specify Requirements) -----RP—=P 1- I --------- -- . - . --------- -. _._ t - - �--- _ �(Drawexisting 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 Sart Joaquin a 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 subiect Workma Compensation laws of California." Signed - ------------------ Owner ------------ ---------------------------------- BY Title -- (If other than owner) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUEDI ----------------------------- - DATE ----- 7 ADDITIONAL COMMENTS Z1` --------------------------------- ----- ----------- ----- ------- -----DATE ----- ------------• ------ 1 ---- ----- -- - ----------------------- —\µ- 1 - - ------ --- -- Final Inspecri ----- ---- ..... ------- ----Date .-- SAN JOAQUIN LOCAL HEALTH DISTRICT '. E. H. 9 1-'68 Rev. 5M w