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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -----=--------•---------------- Permit No. --__- (Complete in Triplicate) -�--'-J-� -------------------------------------------------- ------ This Permit Expires 1 Year From Date Issued Date Issued !-_�7`-o, Application is hereby made to the San Joaquin Local Health District for a permit to construct and installr the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: l f �j If JOB ADDRESS/LOCATI 1 - -- --------- - -------------------------CENSUS TRAGII -------------- Owner's Name --=--- I� -- ------------- -- -if----- ---- --- - - - ---•--------------=- -------Phone ------=i--- ------------- ----------- Address �� 7 7 ---- t City ------ -�---- I _x____. !cense # ��Phone .-�_ Contractor's Name ______ -------•-----------------••- Installafiion will serve: Residence Apartment House ❑ Commercial ❑Trailer Court ',❑ t' Motel ❑ Other r'-------------------,------- `-�- Number of living units:---_1------ Number of bedrooms- ____7"Y_Garbage Grinder .----------- Lot Size fie-ice--- ---- ----- } Water Supply. Public System and name -----------Z----------------------------------------------------------•----------------- -------- -Private Character of soil to a depth of 3 feet: Sand ❑ El' Silt Clay ❑ Peat El Sandy Loam , Clay Loam ❑ p 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.) 11 11� NEW INSTALLATION: (No septic tank or seep be pit permitted public sewer available within 200 feet,) V PACKAGE TREATMENT M SEPTIC TANK f;7 Sizey/_"----,.f ----------------- Liquid Depth _V-.-________-____-_--11 \-4' Capacity ]_k—QO Type s= "Material__ No. Compartments _-�------------- ,,,,,/Distance -------.---• V ! Distance to nearest: Well ___________ a__�_ ___-------Foundation ......f�'_---------- Prop. Line ___.�_____-:________ i LEACHING LINE [ No. of Lines ----�_'___-'------- Length of each line--�8--- ---------- ---- Total Length �.:--1�an----------____-- 17' Box __ _.__.-___ Type Filter Material _____-__1 ______Depth Filter Material ______�_�_____ ____________ IM ------ ox "nearest:Well'____ *�__ Foundation -------- --------_______ Property Line -----�`_�________________ SEEPAGE PIT [ ] Die pth.....-------- Number ---------------------------- Rock Filled Yes ❑ No .C] ' --------- �---`�------ - ------- Water Table Depth ____________ _ ___.Rock Size __._____ ______________ Distance to nearest:-Well ----------------- -------------------'EFoundation -------------------- Prop. Line ----------------.---.- REPAIR/ADDITION{Prev. Sanitafiiari Permit Y# --_-----.------------------ ~-------- - Septic Tank (Specify Re --- Date ----: :--------------------------) Requirements) -------- - ---------- -------- - ------------------------------ - I Disposal Feld (Specify Requirements) I� IIti ------------------------ I_ ----------------------------------------------------------------------------------- ----------------------------- �=- ---•- - - -- '�r --- (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!l 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 persI n in such manner as to become subject to Workman's Compensation laws of California." Signed ---------------- --------- -- -------- } �1------ -i - -------- Owner J Titl .. By -------------- ---------------------- ----- ---------- - ---- --- --- (If other th I�n owner) FOR DEPARTMENT LISA ONLY APPLICATION ACCEPTED BY - - ----- ---- - --- ------------ ------------------- -------- --------------------------------- DATE _ � �_' --------------------- BUILDING PERMIT ISSUED ----------- - --------------------------------------- ------------------------------- DATE > ADDITIONAL COMMENTS ---------------------- --------------------- ----------- ----------------------------------------------------------------------- - ---------------•------ l --------------------- ---------------------------------------------- ! ----------- -------------------I---------- --------------•--------------------•----- Final Inspection.b I it _ __ - -p Y ---------------------------------------------- Date 7/0 T 4. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 " 1-'+68SM .Rev.