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T FOR OFFICE USE: u R ] �f APPI1CATi®N ,FOR SANITATION PERMIT � '� Permit No.. 'M.` ..." -�. .^..... �. -- --4 -(Complete-in Triplicate) . . .b- �-- -- - - -- --..-� ._ Date Issued _.��o "t" "—"This•Perrnit'Expirws i-Year-From Dateissued-^�-�--- - - Application is hereby made to thelSon Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance wit County Ordinance No. 549'and existing Rules and Regulations: JOB ADDRESS/LOCATION ---1xg------ ,� - -------------CENSUS TRACT` Owner's Name ----10.15 -LIP ,.- --------la-l"zi-e��o. ---- ----- -----------------------------------Phone -Address -----//9--- -- :�Z --------------------- ------------ City /a ---------------------------------------- Contractor's --- ----------------------------- Contractor's Name � r__ .A ,moi_ _ _q' � ,5--------------------License #/61907oK______ Phone '41 _ `0"___ Installation will serve: Residencpartment House❑ Commercial :❑Trailer Court ;E1 ' I Mo?e, ❑ Other ---------- r I Number of living units:____ Number of be rooms ______ _____Garbage Grinder __________ Lot Size -- /� /4-4-------------- Water __________ R. ._. ,. _ - w.. .- Water Supply: Public System and name --------------------------------------------------------- -Private ❑ 6 Character of soil+to a depth of 3 feet: I Sand-E] Silt❑ Clay ❑ Peat❑ Sandy Loam '❑ Clay Loam ❑ Hardpan ❑ Adobe* Material ----- - _ If yes,°type=____" _____:______ (Plot plan, showing size 'df-lot;location of system in relation to wells, buildings, etc. must be placed on reverse side.) S NEW INSTALLATION: (No septictankor seepage pit permitted'if"public sewer is available within 200 feet,) t t PACKAGE TREATMENT [ SEPTIC TANK'[ J Size-----------------------------------------'----- Liquid Depth -----------------4__------ s= " Capacity !_-- ?------------- Type -------------------- Material---------------------- No. Compartments .......... Distance to nearest: Well -------------------------- ��rk s ----------Foundation -- - - --- Prop. Line ----`---••--,--•----- ' LEACHING LINE s [ ]" No. of Lines i------------------------ Length of each line---------------------------- Total Length ___________-____________..__ "D' Box ------------ Type Filter Material ____________________Depth Filter Material ----------------------------------------_--- Distg1,ke:to nearest: Well--------------------------Foundation _ ----- Property _Line..---:----------- ------ SEEPAGE PIT ] Depth --------------- Diameter ________________ Number ________.._______.__________ Rock Filled Yes ❑ No i I Water Table Depth ------------------------- - Rock Size -------------------------------- ,:.1 € Distance to. nearest: Well _________________________________ ______Foundation ------------------ - Prop. Line _-_-_______-=--___-__ REPAIR/ADDITION(Prev. Sanitation Permit# -------------- Date ---------------------------------- Septic ____________._________ _____-_---Se tic Tank (Specify Requirements) ' - ) ----------- ------=-------- Disal Field (Specify)Requirements)',_ __ _ _ __'_ _� _ r - f,- iE.r ---------------- . -- ----------z +-'rte'-------- - - - - - ---- ---- +- -�--- o ,.. `tc� ' � r - -- ------ ------------------------- -- - T-- -:- e L - ------- (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 "I certify that in the performance of Phe 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." l r 51 Signed --- ---------- ------------- --- ` Owner x � � BY = •------- TitleG. t (If other than owner) FOR DEPARTMENT USE ONLY I i APPLICATION ACCEPTED BY --- � a'�-r --- DATE r BUILDING PERMIT ISSUED ----------- -------- ---------------=--------------DATE ------------- --------------- ------------- ADDITIONAL COMMENTS _____________________________ ! = ---------------------------------------------------------------------- ----------- ------------------------------------------- --------------------------=--------------- Fin - In -- --- -------------------------F Final Inspection by: Date .._. � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M k' "