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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ------------------------------------------- - P P Permit No: --- ---- y-.... (Complete in Triplicate) I Date Issued -__/-�5- 7y + ___.___________ ______ J------_------_--------------- This Permit Expires ll Year From Date Issued ------------- Application ----•- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work'herein a described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION t ------ r `-r-/ ------------------ -CENSUS TRACT -------------- ----------- Owner's Name ------ ------ [? .---••----•---------------•------------------ ------------------�_Phorie ---------------•-------------------- Address ------- _f 4 -----------------•- City ------- -------------------------------------------------- Contractor's -- ------Contractor's Name :_ .� -'------------------------ License , -L� � - Phone -----------------. --------- Installation will serve: Residence`&I Apartment House❑ Commercial ❑Trailer Court 0 ,.Mote! ❑ Other ----- L� { a Number of living units:_ --- � gin 'Lot Size ----------------------- -------•--- t Number of bedrooms ___ ________Garba a Grinder .___._____ / Water Supply: Public System and name------------------------------- --------------_---------------------------------:.-------------------------------Private ( ; Character of soil to a depth of 3}feet: Sand'❑ Silt❑ 'Sa'ndy Loam Clay Loam E # Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ______--------- _________" (Plot plan, showing size of lot, location of system in relation to wells, b liu dings, .etc. must be placed on .reverse side,) NEW INSTALLATION: (No septic tank or seepage pit; er�m tte_d if public sewer is available within 200 feet,) PACKAGE TREATMENT j ] SEPTIC TANK'[ J x Size__ Y'/ '__ --------- ---- Liquid Depth ___ ---_-_---_._--__ Capacity `a1 ----{ITYPeI '�� Material------------- ------ ''No. Compartments ----- ............ \. , 1 ! 1 Distance to nearest: Well --- 7-- _ ---------Foundation �.;2---------------- Prop. Line ---------------------- . LEACHING LINE [ ] .,No. of Lines _--_ ----------A_,__ Length of each line- j ---` Total Length -TIT,<------------------ 'D' -------__- -- D' Box -__ Tjipe Filter Material Depth Filter Material ___ _ _---j.-----_ _ ..__.. ` n" •~= --------- Property Line. -----•--•----•---•-•---- - Distance to'--nearest. Well Foundatio SEEPAGE PIT [ ] Depth ------------------I- Diameter Number-- .__..____-_ ._:------ Rack Filled Yes ❑ No i❑ Water Table Deptli = r Rock Size REPAIR ADDITION Prev.Distance anitation Permit r#We�l__�.___ _____________________-___-^µDatendation-�_______-_______.__ Prop.- Line -------------_---- ,.... CSS. Septic Tank (Specify Requirements) ---------------`-----------------------'-------------------- =------------=' ----------------•--•---.-•--•- Disposa! Field [Specify Requirements} ------- - - ------ ---------------`---------------------------------------------------- --------- -yam / Y .---------------------------------------------------------------- ------- ---- --__ ----------------------------- -___--__-_ ---------------------------------------------------- 1 -------- ------------------------------------------ _-_------------- --------------------- --------- ----_---__---__-_--_-------____-_-_____--____- (Draw existing and required addition on reverse side)?` ; . I hereby certify that I have prepareci'`this`application and that the work will be,dobe:in accordance with San Joaquin County Ordinances, State Laws, and fRu'les,and Regulations of�the.San 'Joaquin-Local Health District. Home owner or liven= sed agents signature certifies the followifi'gi �' r "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 or an's Co pensati.on Jaws of California." = I Signed ------ ------ / " .. / Owner BY - ------ ----------------------------------------- Title . ---- - - `--------------------------------------- (If ----- - - ---- - other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ---'- DATE --------`------- Dt BUILDING PERMIT ISSUE --=----,f-- ----------------------- ------ - ---------DATE ------------------ ----•------- ------ ADDITIONAL COMMENTS ------.. x - - --- ---------------- -- - - ----- ---_------- ' =-•-- --------------------- - - -- -------- --------------------------- -- -- ------------------ - e , Final Inspection by.f'----------------------------------- ------------------- `' a ; Date �1l 7jSAN;JOAQUIN LOCA ISTRICT h. E."H.• 9 1-'b8. Rev. 5M w. ..