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FOR OFFICE USE: I '3PPLICATION FOR SANITATION PEI T _ .--------------- -----------------•--------------------- (Completein Triplicate)- ° Permit No. 1 ---,Z_1-- 2 = ------------------------- f, r ;Date Issued -�.-=- =- -=- ________________ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Orch a, ce No. 549 and existing Rules a d gg titYns. JOB ADDRESS/LOCATION I? _ -' -- -,--l�-_t"--- ( -t-ham --Q-�jl-- _-- II A , t C�aSUS TR CT Owner's Name , [Y : '1 1-- -----------= Phone --- .�. � Address _ .- City Contractor's Name � 0- -- -------------- - --------- ----------------- ----------Lice nse# / �1 ane ------------------------------ { Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other------------ ----------------------- ------- y Number of living units:______ ___ Number of...bedroomk3---------Garbage. Gr r�'der•-- `- Lot Size - '_v_____________ -- -T i' ` .' -- Privat Water Supply: Public System and name -----------_-_---_ - Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay 0 Peat❑ Sandy Loam ❑ Clay Loam Hard an Adobe ' Material/� P ❑ Fill -- If yes..type ------- ---------- ----_ (Phot 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'avai1A16 within 200 feet;) l sC PACKAGE TREATMENT [ ] SEPTIC TANK f / Size_____ ` ` ------- Liquid Depth --- ---Z��-------- Capacity JAVA------ Type E_7�L'__�-�a.S�`_ Material � _��.a�No. Compartments _�_____ ._:s:... � Distance to nearest: Well _____ _ __) Foundation . __!�__1_________t.Pro Line . ' - :.,;_.__ ----- --- - P• / ,. LEACHING LINE [ No. of Lines -----�3-------------- Length of each line----$0 ________.______ Total Length R-9A....._....... ._ i 'D' Box ---Y� _� Type Filter Material - 1 __if4 .Dep#h P�I#er Material --- ��-----•------------ ...... Distance to nearest: Well _-P-_r Foundation.'_1�______ ___`__ Property Line .................. SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------- ----- Rock Filled Yes '[] No C ? Water Table Depth --------------------------------------- --------Rock Size ------ =---------------------- i I Distance to nearest-, Well -.-_-_-•=----•---•-------.F_oundQtis�o._--'----------------- Prop.. Line ----------.'x--.----- I REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------------- -----} i SepticTank (Specify Requirements) -------- ---------------------------------------------------------- ------------- --------------------------------------------------------- DispasaE Field (Specify Requirements) ______._____ 6 .. ------------------------------------------- 3 ------------=-------------------------------------------------------------------------------------------------- - -- -------------------------------------------------------------------- •--------- - ------------ -(Qraw existing and required2he -----i --------------------------------------------------------------------- -------- I herebycertify that I have prepared this application/ah on k reverse side]fy p p ppwork will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regthe 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 whmit is issued, I shall not employ any person in such manner as to become subject to Workman"s Compensation laornia." Signed -------------------------- -------- ------------------------------ Owner By ---------------------------------- Title - -- - ------ - ------------------------------------ (If other th caner FOR .DEPARTMENT USE ONLY � APPLICATION ACCEPTED BY --------- --Gx- ------�•--5---------------------------------------------------------------- DATE: p-,0-2!---------•---- -------------- BUILDING PERMIT ISSUED --------- -------- ------------------------------------------DATE ------------------------------------------- ADDITIONAL -------------------- - - -- ----------------------------------- - ------------------ ADDITIONAL COMMENTS --------------- --------------------•-------------------------------------------- -------------------- --------------------------------------------- ------------------------------------------------------------------ --------------- ----------------------------------------------------------------------------------------------------------- -------- ------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------•- M -------------------- ----------.- ---- ---------------- F -- -------------------- Final Inspection b . ----.Datea --------------------- SAN ------ -------------SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M