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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------ ---------- ------------------------- 4 " (Complete in Triplicate) Permit No, _7.Z_'___._____j_ ------- --------------------1-`------------------------------ % ___ -- -------- ----- This Permit Expires 1 Year From bate Issued Date Issued I Application is hereby made tc th- 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: E y, JOB ADDRESS/LOCATION -----------j_3_J-91-_-------44 &__ -.---�Ia✓lacaL--------------CENSUS TRACT -------------- ----------- Owner's Name .___._-_l ` IIIi ----------------- ------------ -:---- -- ------- ---------------------- ------ ----------------------------•--• Address --------1-319-1-----�-S/ ------------------------- City a - -•--- Contractor's Name ------------SEZ- ----__SEI " k _ License # ------------------------- Phone -------------------- i�-- - -------------------------------------------------- installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court ',❑ i� Motel ❑ Other k . Number of living units:---- Number of bedrooms __3------Garbage Grinder Lot Size ___________________- Water Supply: Public System andi�name ------ •---------•--------' - f Private D/ ' Character of soil to a depth of 3 fleet: Sand' Silt:❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------ ----- If yes, type ________.___.__________ a�. (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 permitted if public sewer is available within 200 feet,) GI PACKAGE TREATMENT f I SEPTIC TANK Tor," Size_______________------------------------------------------------- Liquid Depth ------- +____________. Capacity__.4 00_______ Type Material�gWl� No. Compartments __ .!____._ -:.._- � l 1 ` ,Distance p:to nearest: .Well ___/_6__�________________________Foundation __�a_--_______-___ Prop. Line ...7e-_`=_,------ �I ` E No. of L'fnes _�-__-____._ __ Length of each line___8�___________________ Total Length�l� �.__......_....__ 'D' Boxfi,eO------- Type Filter Material --------------------Depth Filter..Materiaf ---------------------------------- _........ \ Distance,ito nearest: Well --�7 `_--___-_____ Foundation __.��_'------------ Property Line ____ad`-------- SEEPAGE PIT [ ] Depth;'_ _�---T------------ Diameter ------------- _ Number _______._________x___. ____ Rock Filled Yes ❑ No' o i II ' Water Table Depth ------------------------------------------------Rock Size -------------------------------- s Distance fio nearest: Well ____________________________ __________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation, Permit# --- ----- _________________________ Date ____--..__________________________) Septic Tank (Specify Requirements) '________________ Disposal Field (Specify Requirements) ------------ ------------------------------------------- ---------------------- - -•----------- il I -------------------------------------------------- -------------------------------------------------------------------------------- - - ----- -- -- ---------- --------------- $ I� ------------------------------------------------- -------------------------------}---------- i (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, dome owner or [icon- I I sed agents signature certifies the following: g "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 s4biect to W kma. ' Compensation laws of California." Signed ----- 4....--- - --- Owner By --------------- - -- - - -- - - - - - - -- -------II- ------- Title - (If other than ownea`) I` FOR PIIEPARTMENT USE ONLY , APPLICATION ACCEPTED BY ----- _ .-_`_ __ _ _ __ DATE BUILDING PERMIT ISSUED ---------0--------- DATE ______ ADDITIONAL COMMENTS .--,3-9 __�9_!M _ ~ _____ ----------- ----------------------------------------- --------------- -------------------------- ----- - M---------- - _ ---------- it ------------------------------------------------------------- ---- ------ Final Inspection by: --------- - ------------- ----------------------------------- ---------------------------------Date �l`17-may ----- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M