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FOR OFFICE USE: APPLICATION FOR SANITATION PF^'AIT -------.------------------...--------------- Permit No. (Complete in Triplicate) 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 Ordinance No. 549 and existing Rules and Regulations: L JOB ADDRESS/LOCATION L---'0 �z7 is ---- A1-0) I �'I�'- CENSUS TRACT 7_. _... Owner's Name .-----.-- j1 G11i- L l,?------------- 1.�� .1i J /�i C -1 i N r�:-�--------------.--Phone Address - • L; -t1�------------------------.--. city -' r >( t - ----------------------------------------- 6" ---'-'- -- ------- 6" Contractor's Name --. -------------_-- - - ----------- ------------License # ------------------------ Phone --------_----_---------- Installation ------- _..- - -- Installation will serve: Residence ❑ Apartment House-E] Commercial❑Trailer Court 'C7 Motel ❑Other ocf, Number of living units:- ----- Number of bedrooms --_-Garbage Grinder ------ Lot Size ----- -��4_-1 c-..`>.---_..- Water Supply: Public System and name - ---- ---------------------- - - ----- ------- - -------- ----------------- Private © " r Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam lj'— Hardpan 0 Adobe ❑ Fill Material ---/V0 If yes, type -------------------------- (Plot .---_---_(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 if public sewer is available within 200 feet,) � -'z��- .... PACKAGE TREATMENT [ ] SEPTIC TANK fq—' Size------ - >-- _ e------------ Liquid Depth --- ------------ - �C. i� �� t' } ' - C Capacity ..--�:---------- Type �-�S::L��-_-: Material---'--_l:.:..-1� Na. Compartments ----------:---- C Distance to nearest: Well ------------___S-6----------Foundation ---------0- --- Prop. Line -----------?i - ...-- LEACHING LINE [ ] No. of Lines --------------------- Length of each line--.----_-__--.-.--..--_- Total Length --------_.-_-.------------ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------- ----------------- ---------.-...... F) Distance to nearest: Well ----.......�(.1- Foundation -----------W------ Property Line ---------..._-.--.-.--- SEEPAGE PIT ] Depth ../.0__-_---- Diameter X.-j---- Number ------- -- _ _ � ------ -- .-- Rock Filled Yes No -- Water Table Depth ---------------------------------------------Rock Size ----------------------_------- Distance to nearest: Well --- ----------------- ................Foundation ------------------.- Prop. Line -------------------- REPAIR/ADDITION(Prev. Sanitation Permit# .._............._-__- _--------------_ Date -_--_----_-.------------------) Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ---------------------------------'_' ---------------- ---- ---------------------------------------------------------------------- ----- [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 becoM subject to Workman;s Compensa�on laws of California." Signed -,,if,.i-=F j` ' - -= - --- ------------------ Owner By ------------------------------------------ - - --- ----------------------- Title .. .. - (If other than owner) f ff. W. FOR DEPA YIr1ENT USE ONLY APPLICATION ACCEPTED BY ----- TO h -------------- - -------------------------- ------- -- ------------ DATE - { �L'-A�-------------- BUILDING PERMIT ISSUED --- _p -.... - - --------DATE --------------------------- ` ADDITIONAL COMMENTS . _ZLL - -n - L)- tT flR -�)LV/1� - p nE�kFl�t nt0 X ------------------ --- ------ - - ------------- --------------------------- -------------------- --- - -^--� ------- --- ---------------- ------------------------- --- ----------------------- - - --- -- Final Inspection by: -- _ �----- Date _--- - /.� -�- -.- - -- -- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M