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FOR OFFICE USE: 9' roo APPLICATION FOR SANITATION""`?RMIT ff Permit No. -- -- ---------- - .- ;Complete in Triplicate} ., tttUUU ` ` .--------- k ------------------------ This Permit Expires 1 Year From Date Issued Date Issued _21 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 exist) g Rules and Regulations: i JOB ADDRESS/LOCA? �j�-/��'.f� -- -'�- {�-'� �'�-�s.��'�„J��'f�--�l�-- �17S AST -------------------------- Owner's Name / ---------------------------------------------------------Phone ------------------------------------ y�, Address l�� :�� / '�' Lr -- - - ------------- ----- City `/ --; Contractor's Name _.__ 1;. � ce''�_________________;!i___-__.__" License #��!��_ Phone��a��.l�/fir Installation will serve: ResidencelKApgrtment House"❑ Comm ercial ❑Trailer Court f;(] . W MotelOther : �d�-" ❑ '. 1 f, Number of living units:---/---- Number of bedrooms ---- ----�!Garbage Grinder __,�/�__ Lot Size - ,� ��/�.._.._. v Water Supply: Public System and name ------- --- ----- `-------------------------'----------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt Clay bQPeat f Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Mgtendl/}_�___.i"-tri-4 type ________________-_-___---_ - y ! 1 - 3- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) %P '00" 0`,l NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK Size__ __ 1F:_t✓_ ----------------- Liquid Depth —---------------- Capacity 111", P_ :____ Type `P __�____ Material ----- No. Compartments - '-.......'__.... Foundation- ---- _ Distance to nearest: Well --_- -__ r � � Prop. Line __ -___---••�- -f LEACHING LINE No, of Lines ----/---------------_ Length of each line------- --------- Total Length 'D' Box -NP-- Type Filter Material 1� 9 Depth Filter Material �_� --------------------- t � will __ y Distance to nearest: Well __ ___________ Foundation _/'%O__--_-------- Property Line �w--______--.-__._ SEEPAGE PIT Depth t -------- Rock Filled Yes No C l � p - - - - --- --- Diameter -----------�---- .Number - - -- ❑ �❑ *Water Table Depth ------------- ------. ----Rock Size -------------------------------- Distance to nearest: Well ---:--f--------------------------------Foundation -------------------- Prop. Line ----------.-___-.-__h REPAIR/ADDITION(Prey. Sanitation Permit# -------------/----------------------------- Date _-_-___.__________________________) r Septic Tank (Specify Requirements) ----- ------------- ----- ------ Disposal Field (Specify Requirements) -------------------------- ------------------------- -------------------------------------------- - r t' t ------------------------ -------- --------------- ---------------------------------------------------------------------------------------------------------------------------- (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 Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following- "] certify that in the performance of the work for,w-hick this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----------------------------- ---- --- Owner BY L' A --------------------- ------------------ Title --------- ------- ---------- (If other t owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------------------------------------------------- DATE 2 ZJ1-------------------- BUILDING PERMIT ISSUED ------------ --- -- ---- ---------------------------- -------------- ----------------------- - --DATE ---- -------------------------------------- - - - ADDITIONALCOMMENTS -- --------- ---------------------------------------------------------------------------------------------------------------------- --------------------------- a ------ ----------------------=-------------------- -------------- -------------------------------------------------------------------------------------------- --------------------- Final Inspection by: � --- ------ - ------ -----Date ---. .----- 4--- 7 ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1268 Rev. 5M G� i