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rGtc GFFicc USc: APPLICATION FOR SANITATION PENT -- --- - - --- - ---- � Permit No. (Complete in in Triplicate) --------- ------ ----------_------------ ---------------------------- -------------------------- --------_-------- -- _-- This Permit Expires 1 Year From Date Issued Date Issued y_.Z_2-_7/.... .� 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 OrdinanFe No. 549 and-existieg Rules and Regulations: ' K�/.L .moi-Ya.-l•-.�c.�L-� �--"�.i JOB ADDRESS/LOCATION _..,.�f"`S_�ft� ----- � - - - - CENSUS TRACT Owner's Name _.f'�'.-� ' C ert?_. b_ F_�._ -------------------------------- ----------- -Phone ----------------------------------- Address .- 40_ - r�- - - City = } Contractor's Name _... ,vf_4 �x_'tewLicense #a J�=._��.7_. Phone __ .. _ --.7_�_ � 1 � �► !- Installation will serve: Residence [ZApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other --------------------------- ---------------- Number of living units:----j_.---- Number of bedrooms -.3------Garbage Grinder �L------- Lot Size - ° ----.,6--- ......... Water Supply: Public System and name ----------------------•- -------------- ------------------------------------------------•---------------------Private Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe X Fill Material ............ If yes,type .--------------------------- (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,) \ PACKAGE TREATMENT [ ] SEPTIC TANK:M Size__�j/�__ ��! __ 8 --, _- -- - Liquid Depth ----y-------------- ---- � Capacity _... Type f U_. _ MaterialNo. Compartments __- --------------- \n� Distance to nearest: Well ------- ___ _ _ _ _ ______________ Foundation (_I�_ __ __.._ Prop. Line ---------- LEACHING LINE [ ] No. of Lines .......3-------------- Length of each line.--- ...... • _. ------ Total Length ._fit/C-_.--.-.._-_ 'D' Box - -_- Type Filter Material ---RgCi_._Depth Filter Material ------ ------------------_- Distance to nearest: Well ........_...__ ° _"__._. Property Line ...... ._�`- -- _ Foundation __./......_. -------------- SEEPAGE PIT [ J Depth .------ -----.------ Diameter _____________ Number - ..._._..____._.._.____ Rock Filled Yes ❑ No i❑ WaterTable Depth ------------------------------------------------Rock Size ------------------- ------------ Distance to nearest: Well -----------___..____-__---___._._.____Foundation ___- --------------- Prop. Line ______________________ � REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------.- Date _.----.--------------------.------) '�N SepticTank (Specify Requirements) -------- - ------- -------------------------------- --------------------------------- -------_---------- •-------- ---------•----- DisposalField (Specify Requirements) ------------------------------------------------------ - -------- --------- ------ --------- ---------- ---------- ---------- --------- ----- ---------------- ----- -------- -- ------------- ---------- -_ - ------------------------------------- -----------------------------------.....------------------------- ---- �. 0 �`- ' - = .•�' - ------ -- ----------------------- - - ( raw 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 Compensati n laws of California." Signedf1------------------------- Owner BY - _- -------------------------- - -- ---- --------------- ------ ------- ---------------- --- Title -----._-------------------------- -------------- ------------------ _ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �� - -�`.�'-��-------��- ------ ---------------- - - ------- ------ - ------------• DATE .-� -- ------ --- --�-------- - - BUILDINGPERMIT ISSUED --- -------_-------------------------- ----------------------------DATE ------ -----• . ----------...- ----- ---- ADDITIONALCOMMENTS --------------------- ------- ---------------------------------------------- ----------------------------------- ------------------------------------------ - ------------------------------- ----------------------------------------------------------------- --------- - --V: - _ ._ - - ----------------------- - - - c . Z ��-- Final Inspection by: `� ' C��----- - ------------ - - .... ----Date -- --- - _ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M