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FOR OFFICE USE: � �� APPLICATION FOR SANITATION PERMIT Permit No. _- - - (Complete in Triplicate) - == ----- f� Date Issued l -1 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 Regulatioh s: - . - ENSUS TRACT ------- w JOB ADDRESS/LOCATION .___---, .cad --------- - '�----- --- ----- --- -- - - Owner's Name ---- - ----- -------------------- ----- --- e I --------- -- Address - •.� $i Cit }.. �' Contractor's Name ---`--=----C �P�' -- -- - ------------- License # a - _ Phone -- Installation will serve: Residence Apartment House,[:] Commercial: Trailericourt ❑ Motel ❑Other -------------------------------------------- r� ' - ' Number of living-units:_`�__ Number of.bed aom __ _ Garba e Grinder �Q- Lot Size-__._-__' -------- L .Aa. .� ---------- -- --------------Private ❑ Water Supply: Public System�i�nd name ------- ------ '--- ---------------- Character --------------Character of soil to a depth of 3 feet: Sand ❑ Silt[] Clay ❑ Peat❑ Sandy Loam •E Clay Loam ❑ ' Hardpan ❑ Aclobek Fill Material ------------ If yes,type -----.__=--------_---------- r (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 within200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK' Size____° = -"; Liquid Depth __ ------- ---•.--- Capacity Type/xr,4Material___h No. Compariments s�-------.-•------ 1 �'`f Foundation w-----------.Prop. Line ---•-17 ....... Distance to neare.st:.Well.,�-"_.""-- , 01 LEACHING LINE No. of Lines -_---�_____-------- Length of each line----- ?-I5 ----------- Total Length ------------- 'D' Box -____ Type Filter Material -C�_e ----Depth Filter. Material _._ ____-------------"___-...."----- pistance to nearest: Well, Ct__ =:Foundation __ �-------------- Property Line .-- "".-----,---•----- SEEPAGE Pi7� i Depth t _ ------ Diameter __.7 --Numbe- --------- ---------- Rock Filled " Yesa' No ❑ Water Table Depth ---------'90_11-------------------=--------Rock Size ----E--`----------- ------------ ��pFoundation Prop. Line _.. Distance to nearest: Well _4o --- "' REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ___________ __-____________""_--) Septic Tank (Specify Requirements) ------ +------------ -------------------------- •---------- -----� Disposal Field (Specify Requirements) *r w ----------------------------------- ------------------------- - -------- --------------------- ------ ----------------------- �'" ---------------------------------------------------------- {Draw existirig and required addition on reverse side} 1 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 1 "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 toiWorkman's Compensation laws of California." { Signed - ----- ----------- ------ ---------------------- ------- Owner _- . Title ----- By ----------- ----- --- — (If ofher than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY : -- ---------------------------------------------------------------------------- DATE ------�- '_ BUILDINGfPERMITISSUED -- -------------------------------- ----------------------------------------- ------------ ------------ -DATE ------------------- ------------ ------ "` .ADDITIONAL�COMMENTS ----------------------------------- - ---------------- ------------------------------ . -- -------=--- ------- - --------------------------------- ---- I ------- ------------------------------ -------------------------------------------- - --- Final Inspection b - Date ___._ 7---Z-- -7----- -------- ----------------------------------------------------------------------------------------------- --- ------- -- ------ -- P y SAN JOAQUIN LOCAL) HEALTH DISTRICT E. H. 9 1-68..Rev, 5M