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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- --=-------------- - 'r> -------------------------- Permit No: 7_L___�.5..� (Complete in Triplicate) ---------- ------ -------------------- ------------------ Date Issued _3 --_--_-----____ 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 col}ar)ce,.lwit i uy rdi allo. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ./_--�. � �'{= '- `----------- -f_f_t� __�� % -��-'------ CENSUS TRACT .. - Owner's Name �� }�7 ? 1 --�- C_y�!,=`�-------- _ -' -` -----------Phone-------------------- _ -- Address - /- J�7�-l'�`�------ --------------- City _ :_�y_ _ -1;Ir�r"1------------ ------------------. Contractor's Name - " '' =/ - Phone _ �-r---_--- Installation /L will serve: Residence ❑` tment House'❑ Commercial ❑Trailer Court i❑ y Motel ❑Other --------------------------------------------- Number ------------------------------------- ----Number of living units:...... Number of bedrooms -------Garbage Grinder lq ___ Lot Size Z�7__ ,l-------- -.------ U�y Private Water Supply: Public System and name --------s� <_- `U= -- ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt Clay .❑ Peat ❑ Sandy Loam ❑ Clay Loam ;❑ Hardpan Adobe r❑ 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.) V NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANKy Size 1` ___________________ Liquid Depth _ ` _- - Capacity _,� - Type & MateriaCompartments -r____-_•--:--__ Distance to nearest: Well ------------ _____________Found-anon _._ 0____ ___ Prop. Line __ '__________---_-. LEACHING LINE [ No. of Lines ___.--_ ---------- Length of each line--- ----- Total Length _ . ............. 'D' Boxy, Type Filter Material �� --Depth Filter Material -----4e_1'_1 Distance to nearest: Well ------- ------1------ Foundation ------------ Property Line ______--. --. SEEPAGE PIT Depth � 5r_/----- Diameter ------ Rock Filled Yes 'Y- Na- ] `y Water Table Depth _R_r - = '-Rock Size ---,//? lr-` --------- Water to nearest: Well ____'- - "__________________Foundation l_� Z----__-_ Prop. Line __S_ -_____ _ REPAIR./ADDITION(Prev. Sanitation Permit F# ________________________ I l ------------------- Date ------_------------------- ------ Septic Tank (Specify Requirements) -------- -------- --------------------------------------------------- _•---------------------------- I E Disposal Field (Specify Requirements) _________________ - ---------------- - - ------------------ --------------- ----------- -----I-- -- ----------------------- --------------------------->------------------------------------------------- ----------------------------------------- (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: T "1 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 Workman's Compensation laws of California." Signed --------------------------------------------- -------------------------------------- Owner l --------------- BY -------- - ---------------------- ----------------t--- �; -l�'--�/l-�`- -�-��-��=------ Title ---- ��_l�-r��,1/ (If other than owner) FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED By ---- 7_7�f_ ----- l -1 ---------------------------------------------- DATE � �f �r�--•--- BUILDING PERMIT ISSUED ------------------------------------ - y -------- --------------DATE ------------------------------------------- ADDITIONAL ------------•--------------- ----- - ADDITIONAL COMMENTS --------------------------------------=----------- v . . _. ------------------------------------/ - ------------- ----- -------- ----------- --------- ---- -- :- ---------------------------------- ------------------------------------ ---- ------------ --------- Final Ins action b p Y= - Date SAN J 4QUIN LOCAL HEALTH DISTRICT { E. H. 9 1-'6$ Rev. 5M'