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FOR OFFICE USE: APPLICATION-FOR SANITATION PERMIT Permit No. (Complete in Triplicate) Date Issued _&7/-5_-U 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 ode in compliance with County Ordinance No. 549 and,existing��ng Ru� and Regulations- "cat e��tions: I G� y tom. �f r CENSU TRACT ___,_____ -------- JOB ADDRESS/LOCATION .-- _ ` ' e- �' Owner's NaTe ---- ---------------------------------------- ----------------------Phon � ----��------- ' � -- ---- ------------ Cit � � _--- - ---•------------------------------ Address - ----------- :--� Address Contractor's Name ___ hon - License - p ----- - -- Installation will serve: Residence RKpartment House❑ Commercial:❑Trailer Court ❑ Motel ❑Other -------- -------------------------------- Number of living units:__/-_--___ Number of bedrooms------Garbage Grinder 441PLot Size _ G ------------ Water Supply: Public System and name _------------------------------------ --_____Private [gam Character of soil to a depth of 3 feet: Sand'[ ilt❑ Clay ❑ Peat❑ Sandy Loam -Clay Loam 'El Hardpan E] Adobebe.❑ FillMaterial O____ if yes,type -------------_------------- (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 perm itted=if :public,sewer is available within 200 feet,) ,,. - Liquid Depth -------------------- PACKAGE TREATMENT ] SEPTIC TANK - Material---- '_ No. Compartments - --------------- ---- Distance to nearest: el ` W ---------------•----•------ Foundation -----+';' ,- ----- Prop. Line ----------=--=•-...... Total Length ----------------------•----- LEACHING LINE [ ] No. of Lines..---f�.--- ---- Length of each line---------------------- -- - { 'D' Box ----------/Type Filter Material,•--------------------Depth Filter Material --------------------------------------- ------ Property I # -------------- Water - operty Line ----------------- Distance to/nearest: Well -------------------�;_.yFoundation ------------------------ n Number ------------------------- Rock Filled yes '❑ No=-❑ SEEPAGE PIT Depth ---- ----------- _ Diameter ------------- --- WaterTqble Depth ------------------------------------------------Rock Size ------------------ ------------ Distance to nearest: Well -------------------- lk Foundation -------------! ---- Prop. Line --------------------- REPAIR/ADDITION(Prev."=Sanitati66 Permit# .------- a - L Date ----------------------------- Septic -_-________ -Septic Tank {Specify Requirements) --- - Q r ; Disposal Field (Specify Requirements) --_le' '' 'i-= - � i `f ---- ----------------------------------------------------- { .a ------------ - ---- �� --- ------------ i Drawexistin and requiredth a.aidition on reverse side) ) I hereby certify that l have prepared this application and t the work will be done in', accordance with San Joaduin County Ordinances, State Laws, and Rules and-RLguia-tidhr. of-the. Stun-Joargvin-fiocal"Hea)th 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 I as to become subject to Workman's Compensatwn`16ws of California.", "E w Signed Oner, --------- Title .'- ----- -- -------- By - other than owner) FOR DEPARTMENT USE ONLY i - DATE � 'T7- ,16,5e----------- APPLICATION ACCEPTED BY s'_ - --------------------- '` �R4O`---- -- --�-. '=T DATES - —� " _"-- BUILDING-PERM IT1SSUED---" - ------- -- ADDITIONAL COMMENTS � �1 r ;1 f, --', --- ------ � 1- --� ------ --- ------------------- 7!==! --- ----- -- - - -- --- --- -- -------------------------------- 27:7 -------- - ---- ---------- -------- ----------------- - ----- --- -------------------- --- ------------------------------------ --- -- ---- -- -- --- - -- -- Date �� f C3 /_ _ -- - --- - --- - _ --- Final Inspe -��----- -- a e SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M