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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------ --------- T Permit No. " _ (Complete in Triplicate) 7 - ---- ---------------------------------- A----------------- This Permit Expires T Year From Date Issued Date Issued _,3 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 - __"- 7�' ------ CENSUS TRACT ------------------ Owner's Name ---- ,�, , e�� ------------------------------------------------------ --------------Phone Address /-Po Z .�;G _tci-- City --------------------------------------- _--- Contractor's Name __ _ ,..�_.fi —r_-----License # . 573 Phone _-____________-_____ Installation will serve: Residence ❑Apartment House-E] CoMmercial�7railer Court ;❑ Motel ❑Other ------ 1rV,113_ j Number of living units_____________ Number of bedrooms ------------Garbage Grinder -----------_ Lot Size _.___-________- Water Supply: Public System and name ----- r_ ! _ GeJZ_, ------ - -I---------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt 0 . Clay F] Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe>( 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: f No septic tank or seepage pit permitted if public sewer is available within 200 feet,} \ PACKAGE TREATMENT [ ] SEPTIC TANK;[ 7 Size_____________________ ------------ Liquid Depth _____-__.____-_______- Q S%/ V Capacity yP -------------- 'eXI P Y T e Material Ca ---------------------- No. Compartments Q Distance to nearest: Wel! -ti----------- -----------•- ----.._Foundation --------- ---------- Prop. Line ----------•--------- - LEACHING LINE [ I No. of Lines ----/----------------- Length of`(each line-------- __.__ Total Length __--_-0-P" " D' Box Type Filter Material ---3f�7-----Depth Filter Material ____f,C _�____. - - --------•---•-•-•-- Distance to nearest: Well __-19'd�-�______ Foundation r -�� ----------- - Property Line _...,�_--------- -••- SEEPAGE PIT [ j: Depth ---------- Diameter _ _ ----------r___ Number _--------l -- Rock Filled Yes No 0 4 Water Table Depth ___,c60.�___________ Rock Size .X f Distance to nearest: Well --- _-_-_-_-_-_----___Foundation -ee-�.- -------- Prop. Line -- ------------------- REPAIR/ADDITION(Prev, Sanitation Permit# ----------------------------------- -------- Date ------ } Septic Tank (Specify Requirements) --------________ Disposal Fi fld m (Specify Requireents} /` Q r -- -- -----��/Zi?'cy,�'- ----fir_-----�----��-'� --------- "DGe�`�r�� .1ff�f r ------ `----- --------D.` 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 liven. 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 ject to 7(I/orknyan's Com ensation laws of California." Signed ----- - ---C = wner BY -------------------------- Title (If of t an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ .___-__ __ ---------------------- ----------------. DATE --- --- f�- ------------------ ADDITIONAL 7� BUILDING PERMIT ISSUED --"-"--- --- ----------" ----------- - - - -- ------------- ADDITIONAL COMMENT _" _ - DATE - - --------------------------- ---------- 6 J� -------------- ----------- ----- ------ --- - - -- ------------------------------------------------------- - --------------------------------------------------- --------------------------------------------- -.nal Inspection by: "------ " � -------------"""-- ------------Date ----- N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M