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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: .... - ��. . (Complete in'Triplicate) J d 73 ----------------------- Date Issued ------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thais application is made iri' compliance with County Ordinance Na. 549 and exis g R2-pnd[LRegulations: JOB ADDRESS/LOCATION - L_� C'i, �J --------------CENSUS TRACT ---------------`IL--------- [a Phone _ �i/ i ------------- Owner's Name ------ -------`-- -- ----- "----- - -- - �� . 6 - 51 -3 � ' a ----------------•--------•-- ` 'fln-'- C.�" ----/t ' . city - --------------------- Address ------- ---------- = 7�A'c' j ��` Phone Contractors Name -- `--- -4,_41 ------------------- d J -----•--- -----.License # ��..�---� ----- Installation will serve: .-�--�, - Residence_❑-Apartment-House,.❑_Commercial Trailer Court ❑__ Motel ❑Other -------------------------------------------- Number of living units:-- ------ Number of bedrooms -----------_Gar`bage.Grinder -__---_---- Lot Size --_---" ------------ ------------•-- - Private Water Supply;: Public,System and name -------------------------- I Peat Sand Loam Clay Loam Q W i Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ❑ Y ❑ ► ► Hardpan F-1 Adobe E] Fill Material ------------ If yes,type ----------------------- q (Plot plan, showing size of lot, location_of system ;n 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,) l/ i Size ray/3 x = Liquid Depth `------------- PACKAGE TREATMENT [ ] !SEPTIC TANKi'{.I p _ _ -_" i' bC1-! T e e�--�t-C195 Material----------------- ---- No. Compartments i Capacity ./ __--_ Yp d ' --- Prop. Line -- ' 1 Distance-to-nearest: Well -------- -------------------------- Foundation ------------------- 7 / r j :---_-- Length of each line-7-=_-_h ' -------- Total Length r_---- �------------- LEACHING LINE'.'[ ] No. of Lines -- ---f - 9 - 1 Depth Filter Material ------------------- -• ----•- fes" -'D' Box -----=---"-- Type Filter Material ------------- -:---- p I . Property Line, Distance to nearest: Well ------------------------ Foundation,..R 4�-'.-------- p SEEPAGE PIT [ ]j Depth _-- - ------- Diameter ---------------- Number ---'=----------- ---- ----- Rock Filled Yes ❑ No ❑ Water Table Depth --------------------------- ----------� -- Rock'Size _ `: ------;i ---------------- Distance to neares#: Well ------------------ f{ Foundation, ........... Prop. Line ...._ - _ - _._.. _ ,� '_, Date -_==-----=� - -----•-------) REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------- r Septic Tank (Specify Requirements) ------------------------------------------------------------------------------- -'--------- k Disposal Field{(Specify Requirements) ------------ ------------------------------------------------------------------------------ -- ---- -- ---- -- - --------------------•-------- -- -- -- --- --- ---- --- -----=-- - - - ----�� (Draw existing an d'regeired addition on reverse side)- I hereby certify that F 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 become subject t Workman's Compensation laws of California." Signed ---- --_'_ ` i �.-------------------------------------------- Owner Title -_-------------- ----------------------- ------------------------------ -------------------------------------------------- (1f,other than owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------ ---------------------------- DATE --DATE ---------------------------------------------- ---------- -------- -----------•. BUILDING PERMIT ISSUED ------------------------------- ------------------------------------------ ----------- - ----- -------- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------- ---------------------------- -------------------------------------------------------------------- ------ -------------------------------------------------------------------------- ----- ---------------''-------------------------------------------------- Final fns ection b _ ---- Date J =� pY: --------------------- ---------•-------------------------- - i SAN JOAQUIN LOCAL HEALTH 1STRICT ` E. H. 9 1'-'68 Rev. 5M f