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FOR OFFICE USE: APPLICAT401 A-OR SANITATION PERMIT --- ---------------1!:3-.6 Permit No. __��--~ 3 - �." (Complete in Triplicate) ( ' 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 6 JOB ADDRESS/LOCATION --- -_ Dd -, ---� - �'---- ------ • ------------- - --CENSUS TWT __.---------------•------- r%/ g�f. '9"70,rd da 6' Owners Name - f/��Y/ -------------------Phone --t.6114442--•------ l Address -------------------------- Gy p'-----•-------- ------------- city-,%-------------------------------------------------•- -------_----•--------- Contractor's Name -.-__-. -- --------------------License � y /--- Phone 39e Y----- Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Traller�Court Motel ❑ Other ---4----------------------------------- _ _. 4 - Number of living units_ -- Number of bedrooms _ _________Garbage-Grinder ____`i''--- Lot'Size l ---------------- Water Supply: Public System and name ________--"___________ f-. -'------------ Private Character of soil to a depth of 3 feet: Sand'D Sift[] Clay ❑ Pea�t.0 r Sandy Loam -❑ Clay Loam Hardpan ❑ Adobe ® Fill Material __---------- If yes, type "________________ _________ (Plot plan, showing size of lot, location of system inrelationto 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,) --- Liquid Depth -------------------------- PACKAGE TREATMENT [ I SEPTIC TANK'[ ] Size"____________ ------------------ _______ r q p i-, ` . Capacity ------------ ------ Type y- --------------- Material__ - t No. Compartments ------ -•---. Distance to nearest: Well ---------------------e _'---------Foundation --;------------------- Prop. Line -------------.-----_ rk LEACHING LINE [ ] No. of Lines ------------------------ Length of_each fine�>� ------------ Total Length .-------- •-----------•--- 'D' Box ------------ Type Filter Material - ----------------/Depth Filter Material ---"-------.-------------------------------- Distance to nearest: Well ______ ________/___ '- Foundation --------. ......... Property Line ------------------------ SEEPAGE PIT [ ] Depth ___.26---------- Diameter a'r_I��--_ Number ------ - - `.---,--- Rock Filled Yes Cg No C r j Water Table Depth ----- 4p --------- -........ =`---Rock Size•`-----bi----------------- Distance to nearest: Wel! _.__ __b0 r ---------- Foundation __� 4--------- Prop. Line JA.............. ! ,r , REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------------�--- -----:-- Date ---------------------------------- Septic Tank (Specify Requirements) ---- --------------- - _---'------------- =- , ------•------ - -------------------------------- - Disposal Field (Specify Requirements) ----------------------------------------------:------ ''-------- -------------------------------------"--------------- ---------44-!!7 2_ y o- --------i J- r _L.S - -� p------- q (Draw-existing and required addi ion 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 its issued;1,'shall not employ any person in such manner as to become subject to Workman's Compensation laws of California.' Signed ------------ Owner 'r. 1 . _ -------------`---- Title ----. 1ti .'= --`------------------ p (if other than owner) CIL FOR DEPARTMENT USE ONLY y APPLICATION ACCEPTED BY --- - ---------- f --------------- DATE G C) Z�-------- r BUILDING PERMIT ISSUED ---------------------- - - -- ----------------- DATE -------------------- ------ -- -- -- -------------= ADDITIONAL COMMENTS ----------------------- )----- --=-------- = - 3,i � ..- ------------ ---------- -------------------------- -------- ----- ------ ------------------- "---------------------- -- ------------------------- ---" `---------------F-------- ------- - ---- --- '_' ar" ----------------------------------- �---- --Yi'- - - -- ----- ------ -------.. -'""-- Final Inspection by: ------ -- F/"17 1 ` Dated - SAN_JgAQUIN LOCAL HEALTH .DISTRICT E. H. 9 1-'6$ Rev. 5M -..�