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V.FOR dOFF1Cb USE: `"APPLICATION FOR SANITATION PERMIT --------------------- ------- ---------- -- ri Complete in Tr;ipiicc&) Permit No. o l! � p-fir -7-�- T ---------- ---__-_-- '"This Permit Expires 1 Year From Date Issued Date Issued rF-_`Z---:_ � 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 complian with County Ordinance<No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _____ �` - -� -------------------- - k 4 - CENSUS T RACT Owner's Name �---- --- one Addre .- �. -. ---------- t Contractor's Name - -.--- - U4---------------License # f _P_._ Phone 'C'43_ Ez2e p ❑ Installation will serve: Residence A artment House Commercial:❑Trailer Court ;❑ Mote! ❑Other ---------------------- --------------------- ' t loll N* •umber of living _units:---_ __ Number of be ooms -_ -_--_Garbage Grinder-A47-___ Lot Size -_f± U Water Supply: Public System and name .------ �i ------Private ❑ ------- ------------ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay: ❑ --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.) T. NEW INSTALLATION: (No:septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT Y [ ] SEPTIC WANK Size--- 4;-k./f�-------- -------- - Liquid Depth ---$-------•--------- - I Capacityl.s,aq_4��i `- Type rr Material- :-_�u- No Compartments ------------------- Distance -___... _ --• --. - O i .1 _ �x t --- ---- -------Foundation ------A0--------- Prop. Line _- -s--------- LEACH ) Distance to nearest: Well --___�.�__f_ _ ING LINE No. of Lines�. ------------- Length of each line------�.,� ` �- - ------------ - Total Length - �'-•------- - 'D' Box .----K--- Type Filter Material 0r�-------Depth Filter Material ---- ------------------------ - ---- Distance to nearest: Well -- �Q--______-_- Foundation ---------- Property Line ----Is— r SEEPAGE PIT ' -W.. Depth - �, __f...... Diameter �__-1_f--- Number _____- �_--__-__ ___-----. Rock Filled Yes ft' No 0 r . Water Table Depth -------- ----------------••--------Rock Size __ t Distance to nearest: Wel! ---- �� ------------------Foundation ---557 --- Prop. Line ------ - r REPAIRJADDITION(Prev. Sanitation Permit# --------------------------------------------- Date Septic Tank (Specify Requirements)____________ Dis osal Fie t --..---- p (Sp cify Require ents) --------- - -------------- --`Eft c s - - - -- - ---- ----------------------------- -------------------- ----- -- - - ------------------------------------------------------------------------ (Draw 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 licen- ' sed agents signature certifies the following: { "I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such mi manner as to become subject to Workman's Compensation laws of California." Signed --------- ------- ' e , . .. ... . ._ Owner BY = _ :�= Titles o� �(If other than owner) 6 • ` OR .DEPARTMENT USE ONLY r j APPLICATION ACCEPTED BUILDING PERMIT ISSUED ----'..-- -_ -'- r-------. DATE - -------------------- --------------- - = ;;_ ---------------------------------DATE ---------- ADDITIONAL COMMENTS ------------------ - . - Ir - ------------------= `~ .. ------------ - ------- --------------- -----_------ ---- - - -- -- - ----------- = / -------------Da Date - .-`-------- Final Inspection b -7__ SAN JOAQUIN LOCAL HEALTH DISTRICT. .r' E. H. 9 _f Rev. 5M f 1