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Vin,,,"" ,,�.. .,• ""'.ri . FOR OFF. 1 u' ..: APPLICATION'FOR'� SANITATION PERMIT -2 �1 •-•- (Complete in Triplicate) Permit No. .�. ..`.._....... 1 .... This Permit-Expires I Year From Date Issued 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 mclde in compliance'With+County Ordinance No, 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ......... _Lf"V1,2111.... ...... .. ....... .......::...............CENSUS TRACT _.......................... Owner's Name . . •- -- -•--•--- ............... :... .Phone Address --------------- .........-------... ...... _ city .... . .......--.................................. t Contractor's Nome ...: c�-- -<'��,r1 ...License # .0 Phone . :. ? II Installation will serve: Residence, Apartment House❑ Commercial QTrailer Court 0 l Motel ❑Other ......................-.................... e Number of living units:............ Number of bedrooms ._,.....Garbage Grinder ............ Lot Size ------je;t ✓....... ............ Water Supply: Public System and name ................................................. -------.....................................................Private (� Character of soil to a depth of 3 feet: Sand 0 .Silt L] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Q0 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:` NEW INSTALLATION: (No septic tank or seepage pit permitted if publlicc�sewer is available within 200 feet,) PACKAGE TREATMENT j J SEPTIC TANK Size:•_-..> .�..�.� '!1.r._._.... Liquid Depth .....</ �!.....{� Capacity __A200.... Type ... .. ....... Material._&'�' No. Compartments ..._�............... Distance to nearest: Wel( ...t_. ..Q.IQ.`................Foundation ......OAV........ Prop. Line .... �f1_........ LEACHING LINE P0 No. of Lines ----------/_1 Length of each line._.....A/0........... Total Length ............ 'D' Box ....�...... Type Filter Material .........0.. ...Depth Filter Material ........ L ...............�.. Distance ito ne crest: Well ....-.1111....... Foundation ......�-t�..-'e..... Property Line ._.. 0......... � f SEEPAGE PIX Depth Diameter �_.�.3_.1. Number ............1............ Rock Filled Yes 16 No Q Water Table Depth404 ._,-_ :.Rock Size Distance to nearest: Well ......,1(iC�. •Foundations F... Prop, Line p ...................... t " I. REPAIR/ADDITION(P v. Sanitation Permit# ...................................••-..-----• Ddte._ ............................... J t pecify Requirements) { �1 C _..._ . �:: - .....E.... r Disposal Field (Specify Requirements) ............................ r, ...._..--•---.._........................................•------------------------------------------- ......._.......... ................. w s. ��R � � ...-•--•-----------•..................................•--•---------••-----•-------_-----.---------..-... --_..........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 F County Ordinances, State taws, and Rules and Regulations ofti#Ice Son'Joaquin .Local Health District. Home owner or licen- sed agents signature certifies the following: E E "I certify that in the performance,of the work For which this permit is.-issued,1 shall not employ any person in such manner as to become subject to Workmari's Compensation laws of California." Signed •-----�- ---`------ --:._._...I...............•---........---�--.,............:..... Owner."® By (If other than owner) FOR DEPARTMENT USE ONLY t APPLICATION,ACCEPTED BY ... DATE ........_ BUILDING PERMIT ISSUED _..... :...............:...... .....--•-•---=' :.. .:.. �--•--- •--•----..I......DATE . ............... ADDITIONAL COMMENTS Y i - :...................... { ----•...............••-----------••--•----•...-----..:.----•-•-------------. .._.......•-----..............------................................................................. ..................................... .............. .... ... ........ ..... -- ................ .............................. ---- ................................. ............. ............--•-•-... •---•---....I............... . .........-•- :.. _.:.._....--- --`...............•.......-•--••••••..I......................... . } { Final Inspection by: ...... . .... .. .... ... Date ......... SAN JOAQUIN LOCAL' HEALTH DISTRICT I 'E._H.13 241.'68 Rev. 5M 7/72 3 M