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r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 9 _ Permit No. ----------------________ �f�-1-�•--- (Complete in Triplicate) -- -- ----- Date issued ' f This Permit Expites 1 War From Date issued '"�ry ------------ , 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/LOCAT! -� '+ ------CENSUS TRACT ------------------ # ------Phone - f Owner's Name --------- --- Address � City k Contractor's Name ----------- -------- f£� ------.License # _lam SGS------- Phone �{b-6- = 6 ------- E Installation will serve: Residence yApartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other -------------------------------------------- I Number of living units:------/... Number of bedrooms ---_!__-----Gara rinder ----------- Lot Size ____-____._ ---------------- ' ❑ Wafter Supply: Public System and name ----------------------------------------- -------- ------------------------ --------------------------------Private Character of soil to a depth of 3 feet: Sandl] Silt❑ Clay ❑ Peat ❑ Sandy Loam -❑ Clay Loam El Hardpan ❑ Adobe' Fill Material ------------ If Yes,type ------------------'--------- (Plot plan, showing size of lot, location_Ma system Jn relation to wells, buildings, etc. must be placed on Feverse side.) NEW INSTALLATION: (No septic,.tank or seepage pit permitted if public sewer is available within 2b0 feet,) PACKAGE TREATMENT SEPTIC.TANK'�Q - Size A_,_�--- ----------------------------------- Liquid Depth -------------------- C Type ---- MaterialNo. Compartments -_--��----.-----0 Capacity _lam YP Distance to nearest: Well -------------------------------------Fo6ndation ------G_0----------- Prop. Line -----.� -:____.--- ' LEACHING LINE No.�of Lines ____ _-------___ Length of each line_:._ - al. Length ,_- -•---------- I 4 De �ilter Mater al ' s ® ,. D' Box --------- Type Fiifer Muferial :_/ p Distance to nearest: Well ________________________ Foundation ----- -------�--- Property Line- -�--.------------Q+ 7�_.x-_"_ Rock Filled Yes No ' SEEPAGE PIT � Depth ---Z�_r--�:f� Diameter ��_�_��--- NurnJber°,,-y-- --k-=- -� �� , .. Water Table Depth ----- ------------------------------ �-Rock Size !h'_ -a--- ---------- F. Distance to nearest: Well ----------------------------------------Foundation -._l-D--__-----_ Prop. Line _ ._______ --..-.-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------••--------------) Septic Tank (Specify Requirements) -------- ---------- - - __•____-__•----------------------------------------- --------- -- -- . Disposal Field (Specify Requirements) ------------ ----------------------- ------------------------------------ ------------------------------ ------ ------ `----------------------------------------- ------- _ _(Draw existing 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: "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 WoTkmari's Compensation laws of California." Signed - ----- Owner .--- - , ------ Title -------- --------------- BY -------------------------------- ' ------------------------------------ (If other than ow r) f t FOR DEPARTMENT USE ONLY t DATE DATE ACCEPTED BY -- -------------------------------------------- BUILDING PERMIT ISSUED ---_-:------:------- DATE ------------•-------- ADDITIONAL COMMENTS .... T ��------------------------------, 5.._ �'�"'' —�� - / .til �---��' �a `r'_ fV .._________._.___-_ Gey t .. ----------------------------------- ------ - _ Final Inspection b - ---------Date _ _-__ --_71_..._j ---- pY- ----- - --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M