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{ FOR ol:l 1 E uSlr: APPLICATION FOR SANITATION PERMIT gyp_/�,�' Permit No- --------------------- (Complete ---------• ------(Complete in Triplicate) Date.Issued --------------- This 3-------This Permit Expires 1 Year From bate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicati6n is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: � le- ----------CENSUS TRACTJOB ADDRESS/LOC TION -------.-- ""I , ---------------------------------- Owners .Name _.. :-._�_ �- --------------------------------------------- - --- -•-- -- -- ---Phone--. Address ---- --- '� f -�l City ^e , ----.License # Contractor's Name -------- j ' ------ t Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court 1 M el Other ---------------------------------------------------- Numb ------------------------ ------ Number of :living units:---. ___ Number of drooms G bag Grinder -- ----_ Lot Size -- ------- - -- --- ------------- 4 ` Private r j , ��,..-�� e ❑ Water Supply:, and±ndme _____ ____---�--1---�-- --------•1-�-_Mm of soil to a depth of 3.'feet; Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ - Adobe Fill Material -_l1C If yes,type ---------------------------- (Plot plan, showing size..;of lot, location 'sof system in re ation towells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank, r seepage d P P p public sewer is available within 2d0 eetJ canoit permitted r --- - l_/__ t L er Liquid Dept e -!� fh PACKAGE TREATMENT J,14.:- SEPTIC TANK{ �f =— Compartments _,----"--. _...�Capacity � o TYPe e._ Materia - < < v:•`. Distance to nearest: Well _._7 -----------------------Fou' dation . ------------- Prop. Line __, """ Length of each line, Total Length ,_ -_ ------------- 7d i LEACHING LINE [ No. of Lines _ _ --------------- 9 J s _ �` D', . _�:_ Type;Filter Material."I- Z,Y Depth Filter Material ____ --------------------------- Box. r--� - Foundation Proper ty Line.:----57-`---=-•--_ Distance to nearest: Well Diameter /J- Number __..._ ------ ---- Rock Filled Yes [ No i❑ ;SEEPAGE PIT :Depth ------ - //// ��,+ - 1 , I t -----Rock Size =�� Water Table Depth -- -; -�u- ----- --- - --- Distance to nearest"Wellz,.- `=------------Foundation -- - -- Prop. Line --- --------------- " ° REPAIR/ADDITION(Prev. Sanitation Permit#:_ - ____ Date __ ____------- --------------------------- ------ ________________________ _ __ ___-____._ 3 _ Septic Tank (Specify Requirements) = = Disposal Field (Specify Requirements) ----------- ----- """" """" -- ----------------------------- -------------- --- ry _ --- _ ____________________________________ ._______._________ (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 liven- sed agents.signature certifies the following- "I certify tliaf 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 to Workman's Compensation laws of California." Signed -------- --------- - ////�� ¢! -------------------- Owner fi'�---lK-�. -------------•- - ------------------- Title --- ��-*- ----�L � ---------------------------------- BY - o er than-owner) FOR DEPARTMENT USE ONLY ,o �� ------------------ APPLICATION ACCEPTED BY _-_ --------------------------------------------------------- DATE --_�'�--- . --- - - -=-------------------- PERMIT ISSUED --- --- ---------- ---------•- ------------- ------------ DATE ------------------------------------------ BUILDING .-- ADDITIONAL COMMENTS ----------------- -------------------- - ----- --------------------------------------------------------------------------------------------------- ----- - ------ --------------- �-?- - ------ Final b - �---- --- - _ ------- -.Dafie �------------ ----- -- ------ ----------------------------------- P Y Fina -- - - SAN JOAQUIN LOCAL HEALTH DISTRICT o E. H. 9 1-'6$ Rev. 5M.