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w ,t VrftC..E..U. .5..E.. ......... . � ...... APPLICATION FOR SANITATION PERMIT y -/,4o (Camyplete in Triplicate) Permit No. ..7......:.....:.. .................... ...... .... This Permit Expires 1 Year From Date Issued Date Issued .—� 74' Application is hereby made to the San .Joaquin Local Health District for a permit to construct and Install the work herein described. This application ismade jp_$ n ri nce A County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ! �z MGK I - --------•-- _._.'........ / ... `:. P US TRACT .......................... Owner's Name - --- ......... ........... ................. J hone ............. . .............. ....................... G Address ....... .. City Contractor's Name --•- .............License # ....I............ .. Phone .............................. Installation will serve: Residence❑A.partment House[] Commercial❑Tra#ler Court ❑ i Motel ` E]Other Number of living units:_. Number of bedrooms l Garbage Grinder Lot Size 3t Ia&& Water Supply: Public System and.name ... ............. ........................•_...--•--.....--------•----.....-•---.........-......._ .......Private � - Character of soil to a depth of 3 feet: . Sand M Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan Q 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,) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer-is available within 200 feet,) PACKAGE TREATMENT j ) SEPTIC TANK f ] Size..- _-•-- C ' �................. . ��dO Of �.. ••----• Liqu€d Depth ............... J Capacity ./_ �....__ Type -• � Material No. Compartments .---•-•--- .. - r Distance to nearest: Well .....................Foundation .. .P.1.......... Prop. Line .... LEACHING LINE [ ] No. of Lines --------------------- Length of ,ea`cchh line-- 'Q 7.0......___. Total Length -...fir--1 _. 'D' Box ..�.___-... Type Filter Material .:._G�" epth .Filter Material ..:........................................ Distance to nearest: Well ........................ Foundation Property Line ........................ SEEPAGE PIT O Depth ----------- ------ Diameter ................ Number ............................ Rock Filled Yes [3No 0 0 - Water Table Depth .....................____..................Rock Size ._.._......_................... p6_ Distance to nearest: Well ............................. ----..Foundation .................... Prop: Line ...................... P .f REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------- ------- Date ..................................I Septic Tank (Specify Requirements) ...........•......------------ Dispose! Field 1Specify Requirements) •- .c ._.. '.....e9Z1 ----------- ---- ---------L•---..__ ... r ----------- ------ ---------•----------------- ------- -------•--------------- _................................... (Draw existing and required addition on reverse side) 1 I hereby certify that 1 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 Ilten- sed agents signature certifies the following: i "I certify that i performance oft a work for which this permit is issued, I shall not employ any person in such manner as to beco sub' ct t orkma ampei ion )aw f alifarnia." Signed Owner BY ••- --------------- --- Title ---.- ----------_ -- {If other than owner} FOR DEPARTMENT USE ONLY ----- ------- •------------ --------- ----------APPLICATION ACCEPTED BY _. - T - ----- .. DATE......�..�-�- -�-----•-- -BUILDING PERMIT PERMIT ISSUED -------------- --------- - ------------------------------------DATE --.-------.-_ ------------- ADDITIONAL COMMENTS --------------------• -• - - -------------------------- --•----......---...._.__._..._....._.... "I------------- ..... -------- ------ -------------------------------- -------------------- -•-------------------•--- ..-------•-•-------•. ------- --- --- - Final inspection by: _•___-•. Date ..�.� .... . .. . .... ........ . �` 7_ .. 3 2!� 1-6f3 F3err. 5I SAN JOAO N LOCAL HEALTH DISTRICT 8/7h 3M