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FOR OFFICE USE: t' APPLICATION FOR SANITATION PERMIT ------------ =------------------ - ---- Permit No,. �- - e (Complete in Triplicate) IDate Issued ------- --------------------------------- --------------- This Permit Expires 1 Year From Dale 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: JOB ADDRESS/LOCAiTiION _1-_ _ _ _ ___.,. A _____ _._.__.__--- /CENSUS TRACT __________________________ Owner's Name .---tel_ L------------73- 1 ---------•--------- -------------------Phone -3/ Address :3 G-------------------------------------------------------------- City -------tl a ----------------------------------------- --------- ----------------------- ------Contractor's Name -- ----- ----------------------------------------------------License # ----- ---:-------------- Phone --------------------- ------ Installation will serve: Residence ❑Apartment House ❑ Commercial ❑Trailer Court ;❑ I- Motel ❑Other ---- ��--------------¢ i�� 4 a7,V,4 Number of living units..--- ------ Number of bedrooms -- X--_Garbage Grinder ------------ Lot Size ___90-- - '"�'Y` Water Supply: Public System and name ------------------ -- ---------------------------------------------------- ----------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ 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 ifpublicsewer is available within 200 feet,] PACKAGE TREATMENT SEPTIC TANK' !`7 �Q .�//d-�----_ Liquid Depth -------------------------- capacity/ ------------------------- [ ) [� Size----------------------�------- -Ca acit _ -- No. Compartments ___.--__._. p Y��---�-Z� Type `"-�-G�S�Materiai C d��_� � .....-•---- W Distance to nearest: Well ------6_0-- �------------Foundation ___ Prop. Line LEACHING LINE f E ] No. of Lines =.X`57_ --.- - - --__-_ Length of each line------- ._ Total Length .__--� -- �_c..__ ,,__,�.��-- i b' Box _.__I-." Type Filter Material _ _cf '[7epth Filter Material _-- ___________________rr._��....__.. , Distance to nearest: Well ---- Foundation Foundation ____4o.'t_---- Property Line. --------------- Number --------------------.------- Rock Filled Yes No SEEPAGE PIT ( ] Depth ____________________ Diameter ❑ 0 Water Table Depth _Rock Size ------------------------_-- Distance ________________ ____Distance to nearest. Well -------------------------------------...Foundation -------------------- Prop. Line _---.-_-_-----_-__--__ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -_--_-____----___----__---_-__-_--J Septic Tank (Specify Requirements) ---------------------------------------------------------------- ----------------- ------------------------ -----• . DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- I -------------------------------------------------------------- (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: "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-be ct to Workman's Compensation laws of California." Signed -------- T4s' --------------------------------------------------------------- Owner By ---- ----- - -------- ------- ------- --------------------------------------------------------- Title ---------- ----- ------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ------ --------------------- ---------. DATE -----317— f ---- BUILDING PERMIT-ISSUED. M_ _ _..�. .� .__ - - - --------------------- -_-DATE---`----_--•------===------ ADDITIONAL COMMENTS -------- ----- ------ --------- ...e.. ._________._________________________________________..________-__-__________.. -__--- ----- �_-_:-------------------------------_------------------------------------------------------------------- ---------------------------------- Final Ins ection b - ---------------------------- - _ ----- --------------------- .S` - --- --- ---- -- -- =- --- - -- -- - f p ,r fy ---------------------------Date / ---------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M