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I FOR OFFICE us� 1,_& d APPLICATION FOR SANITATION PERMIT ---------- - -----------------•---------•--•-••---- (Complete in Triplicate) Permit Nn: 7 :L.Q•_ �. --- ----------------------------------- -------- This Permit Expires 1 Year From Date Issued 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .._.._ .___ c e-s' j - - .. ,fY `� ••----••---- ---..-CENSUS TRACT .......................... Owner's Name -----. 1 -C ....... rr�z,��... ._ _._ _.-Phone fP .�- , a Address � ._� ................. City .�..................... ...................... Contractor's Name ----._-._ r -� ..__ ----------- Contractor's �1 '---_........License #`�::-7-rj...�/._�_ Phone Installation will serve: Residence*Apartment House C❑ Commercial oTrailer Court i❑ Motel ❑Other ------------ ------• ----. -- Number of living units:-_ Number of bed ooms d!......Garbage Grinder`.. Lot Size i Water Supply: Public System and name .... ------- T.:................................:...............Private ❑ Character of soil to a depth of 3 feet: Sand❑ Sil4© I Clay ❑ Peat❑ Sandy Loam ❑ ,Clay Loam ❑ ..,� Hardpan❑ Adobe r Fill Material .-- ----. If yes,type ---------------------------- i (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION: (No septic tank or se�ep�agge,pit pe lnitted if public sewer is available within 200 feet,) t f { l T ]-�'�S / q P ..._- 4 PACKAGE TREATMENT SEPTIC � S� e________________________________________ Liquid Depth ._-.-..------•------- Capacity -----------=- Type--------- `.. Material..... ........... No. Compartments ...................... Distance to nearest: Well ....----`11.............••-_--.......Foundation ................!...... Prop. Line .................... LEACHING LINE No, of Lines ..../_.............. Length of each line--------15--C7-/....... Total Length ...... ....... 1 'D' Box ..../-__- Type Filter Matetial :. o<<C .._Depth Filter Material ...�` ?________________________________ Distance to nearest: Well . _ Foundation .....rQ r..._.... Property '[ Line. ......W__ __-_._.._ �! SEEPAGE PIT Depth s...... Diameter .rr_, Number .......+1 .............. Rock Filled Yes No ] x • Water Table Depth ......... ��i.:.......................Rock Size ----PZ...... _ ,�..._... Distance to nearest: Well ---A"' —.____..Foundation ..... .. -----:.. Prop. Line REPAIR/ADDITION(Prev. Sanitation .Permit# .............................................._......__........_.. date .----....----•-.•----._.._....___-) I Septic Tank (Specify Requirements) ............. ............. .................................. ....... - Disposail Field (Specify RegU'rements) .. '# _- r. ...... .l-............ r .. .. ............•---........--- ----•- --•-------••-------- ------••-------•.. -------------------- ................................. ......---... ---------------------------------------------------------- ---•--.._..... ........ -_-----•----- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this cppiicotloti and that the�.Work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health bistrict. Home owner or licen- sed agents signature certifies the following: . . 6 I r "I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such Manner as to become subject to Workman's Compensation laws of California." Signed ------------------ --:------------ ---------- Owner ,fes BY ---- -- �^�'r a.��a` -_... ✓1rc''e'-h..�- . Title .........`-•'- {If other than own �` FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY __. _ ,- - t.- f ��-- ] ---- - ••..............................•---..... DATE BUILDING PERMIT PERMIT ISSUED ......... -.- __-... __; ..__ DATE ADDITIONAL COMMENTS ----- �- ;- -'� ___ -..... . ----------------------•---•_--------------••------•------ ---•-•---------------------•---.....__----------- -- -- •------- --- .. _ � ..... - - - - ina Inspection by: -t..............� --- -------------. ae -- - --- SAN JOAQUIN A-OCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M