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FOR OFFICE USE: APPLICATION FOR SANITATION PI:R`�'J ------------------------ perm=--------•--------------------- P p ti - lCom tete in Triplicate) it No: -- .-- ---�_.._-- ---- ------ --------------------------------------------- ____ This Permit Expires 1 Year From Date Issue Date'Issued Application is hereby made to the San Joaquin Local Health District for a permit t Pdi n Il the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ;kj-UJU`1—._...._ -r__im,s_-. -3.7Q- --6,__0rWWtCENSUS TRACT _JY-7.......... Owner's Name ----------------------------------------------------- --------------Phone ..-•-----------=-------------------- Address --- —3-7-0 ----------•-----•---_ --::__. City-•--- --------- -------------------- Contractor's Name -- 17.x_---�1' .. _14- - ---------------- -------------------License � t. �2 Phone'`:.-�. U Installation will serve: „ Residence artment House,E] Commercial ❑Trailer Court.-C] Motel ❑ Other----------------------------•--•------------- Number of living units------------- Number of bedrooms _3------ Grinder ------------ Lot Size __................................•--..---- J Water Supply: Public System and name -------=----------------------------------- ------------•----------•---•------------------ .Private �� eob��es Character of soil to a deptk of 3 feet: Sand'❑ Silt❑ Clay 1 .Peat❑ Sandy Loam •❑ Clay Loam 0 Hardpan �c�obe ❑ Fill Material ------------ If yes,type ---------------------------- (Plot plan, showing size of lot, location of system in relation to v+'ells, 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,l PACKAGE TREATMENT [ ] SEPTIC TANK [ j Size-..... ------------- Liquid .Depth ---5' -------------- Capacity _-__. ... j _ Capacity J �© �Yp ---- Foundation p encs :_ ..Q ..-_.� ,--,--,-------------- �M terial•�f�ey.�tsx�SNo� Compartments � CJ -- � p� Distance to nearest: Well L��v a ch line_____-�_d�_.a� Total`-Lenot'. Line ---�_O__:_._. ,� LEACHING LINE [ J No. of Lines .--.--. g e9ch Length -12:Q---------••-� D, Box ..__t.. . : Type- Filter Material-_tZ__. GGbe'p th Filter Material ._._.�- Yp 2 f..,.... `7 f- ---- -- Foundation ---- ----------------- ------- -- ----- Property Line. �� .. , ..._. Number -;....- -----------,tock Filled Yes --No 0 Distance to nearest: e _ SEEPAGE PIT [ j.� Water Table Depth -.___._-� r Diamet f . p �.Q_ - .. Rock Size �Z ------------- Distance to nearest: Well _._.___ .Q ._._.._..........Foundation -0_..._.. Prop. Line-•ZC�_---_--.- �y . REPAIR/ADDITION(Prev, Sanitation Permit# -------------------------------------------- Date -----.---------------------------- SepticTank lSpecify Requirements) ------------------- - ------------------------------------------ ----- --------- ------=-------------------=------------------------------ Disposal Field (Specify' Requirements) ------------------------•--------------------------------------------------------------------------- ---------------.---------------- F -=-------------------•-----•-----------•------------- -----------------------------------------------------------•--------------=------------------------------------- -----_ ---------------- f (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 become subject to Workman's Compensation laws of California." Signed ---- -------------------------------- -•-----•------------- Owner Title --------BY ---------------------- (if (if than owner-i- . FOR -DEPARTMENT USE ONLY APPLICATION ACCEPTED [3y- --------------------------------------------------------- DATE _1A_-,_2 '7-- ------------•- BUILDING PERMIT ISSUED - ----------------------------------- ---------------------------=------------- DATE = fADDITIONAL COMMENTS ------------------------------------------•---- -•---•-- -•----------/------------------------- ----------------•----------------- ---•---•-- -- ----•-------- ------------------------------------------ -----------------------------�-___--- -- Final inspection by: --- j"rT - -fr Date --.X ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT t I E..H. 9 1-'68,Rev. 5M