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FOR OFFICE USS: APPMA'�ION FOR SANITATIONPERMIT -------------------------------------------------------- (Complete in Triplicate) Permit No. _____________________________________________________ F l _________________.__________-_______-______ ____ This Permit E pires 1 Year Frpm Date Issued Date Issued __..��_ Application is hereby made to the aJotfqui Locrwith lfih tri for a permit to construct and install the work herein described. This application is made in complianceoun Ordinance No. 549 and existi g Rules and Re ulatio 5: " cam 4 JOB ADDRESS/LOCATION .11- - - --! t ---lG__.-- '-- - f--- -C'- - -i--6'1-------CENSUS TR ---------------••-------- �► Owner's Name - 1.4 ----------Phone ------------------------------------ Address .-----------__ --Address ------------ 1 A Ci#Yr Contractor's Name --.-- _P. ---------- k- ------ -------------------------.License # f ��-��1_�rPhone _��---_' �_F_�� Installation will serve: { Residence partment House❑ Commercial ❑Trailer Court ❑ r t a r Motel ❑ Other, ----------------------------------- --- eoo Number of living units----- Number of bedrooms' --_____Garbage Grinder _-;igs __ Lot Size �`- - ____ _ UlC7 - i t Water Supply: Public System and name --------------4---------------- -------------------------------------------------------------------------------Private m� Character of soil to a depth of 3 feet: Sand'E] Silt❑ %''Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;❑ I Hardpan ❑ Adobe EI`rVlaterial __ __ If yes, type ____________________________ t. (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 ifublic sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK Siz _ S--------------------- Liquid Depth Capacity'.�'1�- l ._,:__ Type y�_�,+��_ Material CQ)a-c-.A___. No. Compartments �............ �; Distance; to nearest: Well - 0_r------------------Foundation __ - _-_________,Prop. Line --40____----__;______ LEACHING LINE RA No. of Lines _ ------- Length of eacb line---i_( _ ------- Total Length D' Box _ @$___ Type Fil.tet Material !7'�:__ �P_____Depth Filter Material r / - Distance to nearest: Well ___�_-�%____________ Foundation .. .�___ __________ Property Line __ _��......----- s . ....... "`""'SEEPAGE'PIT r. 'Depth __ :____ ___ Diameter �_�______ Number ______ __________________ Rock Filled Yes Ida C] Water Table Depth ------ ----------------------------Rock Size -- li_ -�____-- Distance to nearest: Well'----/(.1 ---/---------------Found-ation ___/�_.--__ Prop. Line F REPAIR/ADDITION(Prev. San itati&n-'Perm i- ---_:'^'-------------------------------- Date --------- % 1________________________J . k Septic Tank (Specifq,RequiremeFnts) --- ------ ---------------------------------------•---------------------------------------_--------------------------- Disposal Field (Specify 'Requirements) ------------- - ---------------------------------------- ------------------------------------------ --------------- - -------------- - i i (Draw existing and required addition on"reverse side) ' f I-hereby certify that--I have prepared this application and that the work will be done ir accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen,. sed agents signature certifies the following: t "1 certify that in the performance of the work for which this permit'is issued, i shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." - __ ` = " Owner _ = Signed - - - -, ------- Title ----------------------------- (If other th o ned FOR .DEPARTMENT USE ONLY -------- -------------------------------------- DATE -- ----- BUILDINGO$ Y PERMIT IISSUED - - --- -------------------------- -------------------------=--------------DATE ------------------------------------------- ADDITIONALCOMMENTS ------------------ ---------------------------------------------------------------------------------------------------------------- --------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- -- - ------- - - ---------------------------- ----------------------------------------------------------------------------------------- ------------------------- ---------------------------------- -- - - lr Final Inspection by: Date �f-- --�'�--------------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT y E. H. 9 1-'68 Rev. 5M