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FOR OFFICE USE: ?;i;��PLICATION FOR SANITATION 177" AIT 9S =------------------------------ ---------- '' � ' (Complete in Triplicate) Permit No. ----- - ------------------------------------------- "` Date Issued -------____ -------------_.-__-__---------------___-- t` � -This Permit Expires 1 Year From Date lssu� � .� Application is hereby made to the San Joaquin Local Health District for a permi co s ruc ar7install t work herein r_ described. This application is made in c mpliance with County Ordinance No. 5 nd existing Rules and Regulations: 0 l` JOB ADDRESS/LOCATION _-� ......-�- ------------CENSUS TRACT ------- -- - -.- -•-- F -- • - Owner's Name --_- ------- - _;c/0-X;- Phone _ _ ;(- °iAddress- ------------------- /Ii-AIV -Pi ----- -------------• Cit 5� Contractor's Name ---------------- '----------------------------------------- -License # ------------------------ Phone ------------------------------ Installation ------ ---.-_Installation will serve: Residence ❑ Apartment House� Commercial ❑Trailer Court ;❑ (d Motel ❑ Other _ 6A147--- ai��z'__ o_`_°_. Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size -.-- k—!! -V--a�, ----------- Water Supply: Public System and name -------- -----------------------•-----------------------------------------------------------•-----------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ 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 pyblic sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK f ] Size__r ----X----1 -._ '-__ yam------ Liquid Depth ------ --------- ----------- Capacity _A Q.0-------- Type -------------------- Material_-�u� -� `� No. Compartments '�� - ----------------•- Distance to nearest: Well ---- j!�t'-_�-a- ----------Foundation ...... /-----_- Prop. Line ------ LEACHING LINE [ I No, of Lines --------/------------- Length of each line--------- Total Length ....... ---___-- ,j- 'D' Sox ------------ Type Filter Material Filter Material ------ -f----------------------------- hrf 0 -----d ------- Property Line - •-- ----- - f Distance to nearest: Well -�------------------- Foundation �___-_ d -------•--•--� SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number _ --------------------- Rock Filled Yes ❑ No i❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------_---------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) --- -- -- ----------------------------------------------------------- ---------- ------------------------------- 30--------------------------- le Disposal Field (Specify Requirements) �� -°- � ---- - ✓!'�p------X------d Q .. --- ---r ,x J ! p / 1 1�— jT !/ - ------ r� --�-- ------t##I-�'tif+a---- ----------------- ��`'c�------/--J--------�`-p,�"_Y�� -- �"`----��T----��-'� (Draw-existing and require'd 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, I shall not employ any person in such manner as to beco esuct to rkman's mP ensation laws of California." Signed ----- - --- ------e---- --------- Owner 't BY -------- ------------------ ---------------------------------------------------------------------- Title ------------------ - --------------------------------------------------- (If other than owner) EPARTMENT l SE ONLY APPLICATION ACCEPTED BY ---- -1�------------------------- DATE ---- - Q �. ............ BUILDING PERMIT ISSUED ----------------- ----------------------DATE ------------------------ --- - ---- ---- - ----- --- --------------------------- --------- - - - A- DETI NAL MME-4T5 - -- --- - --------------- J --- ------- - -- ----- - - --- -- ----- t - , -- ------ ------- e- 1-a/6/16-------------- - --------------------------- --------------------------------------------------- ---- --` - --- ----=------- Final In ection b --- --Date ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M