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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. . j' (Complete in Triplicate) .. ,. I 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 JOB ADDRESS/LO TION 1 61;-.2 P ..4....`-'� .�.::.... CENSUS TRACT I 1 Owner's Name .......Q-f� I !�JE r4.... .............................•--......----................ ,..... Phone Address .. / )100.... Nsr._�J� io e:q................ City .... 1 ...... t f Jo.xo................................. Contractor's Name .F�.i�4'1�..... ' ..License ... Phone ... .. Installation will serve: Residence❑Apartment House(] Commercial OTraller Court fl i Motel Other ... +n k _-. . �i Number of living units:.....!------ Number of bedrooms _.....Garbage Grinder ............. Lot Size ... .. ...... .... ... .......... ...1 Water Supply: Public System and name .................................................................................._........... .................Private Character of soil to a depth of 3 feet Sand[] Silt❑ Clay [3, Peat❑ _San_dy Loa O_ _CIay4Laam Q_;— 4� ............. ........... Hardpan. Adobe Fill Material yes,type . , Q�) (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 Size..__. , ........................... Liquid Depth ." .............. p ty yp .__..... No. Compartments .. Ca aci f .�.. .....• T e . _ ..`� . Material.............. ........ 9de Distance to nearest: Well _.. ...Foundation ../V............. Prop. Line ..................... LEACHING LINE Na. of Lines --------! .......... Length of each line........./ ......... Total Length .......rFO................ 1 'D' Box .J...... Type Filter Materlcl .)..Z.f........Depth Filter Material ---- ............................. ... Distance to nearest, Well .. ...... Foundation .............. Property line ........................ SEEPAGE PIT Depth ." A:4: Ar Number ....... ...... Rack Filled Yes No �(] ' Writer Table Depth ....J A7.;?..:................. .... --_..Rock Size - Distance to nearest: Well .1. !.:.............:..............Foundation ...........:........ Prop. Line ...................... j REPAIR/ADDITION(Prey. Sanitation Permit�l` ....... Date ) [1 i Septic Tank (Specify Requirements) .....................................................................................................•.........I.............................fig 4 , DisposalField (Specify:'Requirements) ..•.................................................................................................................................. � 1 ......................................... _............... ......_.. ..........I.............---.. ......-7......... ......................................................•..........................................._..... .. ! (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be clone In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homo owner or liven. sed agents sig ure certifiQs the following: t. "I certify that I he performance f the work far'which this .permit Is Issued, i shall not employ any person In such manner as to become t tow o pensatl laws of California." Signed ... ..... .... . .. ... ......... . Owner By ...... .. ... ........... .. � • Title« ..... 1....................................---..... (If otherA"o in owner) r I FOR"DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y .. .......... .. .................................................................DATE ..�o.� BUILDING'PERMIT ISSUED-................... -----..-..----••---•...................................................................DATE ........................................... ADDITIONALCOMMENTS " ...................................................................................... . ........ Date Final Inspection b r r .....,� . .. Eli 1 p Y ......... r 3 2!� 1-6t3 1v..i i SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M .1