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FOR OFFICE USE: APPLICATION FOR"SANITATION PERMIT s-6U Permit Na. ---7_________---•-. (Complete in Triplicate) --------------------------------------- - -S - � Date Issued --�-----•--- --- . This Permit Expires 1-Year From Da� te Issued Application is hereby made�to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap�licgtiiin ismade.,in ca`mpliance with County Ordinance No. 549 and existing Rules and Regulations: ' I ' FL; L- ��." CENSUS TRACT ----`_'- ` G dl/1� 1 0 r ---.----- --------------- ''; _=:�* -- Phone JOB ADDRESS LOCATI .. Owner's Name _. ._ -� -- --- -- Address �7a Z City I C�C7 - � ---------------- c -- I1 License #' _ Phone ��,1 ---- Contractor s Name ,t��-�- s--� ---.----- -- .-- -.'---------------- - f �- --- . ! . -- -�- - -- - - I II { Installation will serve: '` Residence (,,Apartment House❑ Commercial ❑Trailer Court [] M tel []Other • =------------=------ I r` I umber of livingunits:__.____ Number lof bedrooms:__ Garbage Grinder � Lot Size --�� I�l -�-��-- �i---"Private I I Water Supply. Public Sysfiern and name h___ Character afs,�il to a,depth,of 3 feet Sand ❑ Silt❑ Clay. ❑ Peat Sandy Loam ❑ : Claylaam ®� `%. Ha�d'pan❑ _.Adabe ❑(Fill Material __ -- , type ----- ... If yes < (Plot plan, showing size f lot, location of system ifelation-to.wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (Noo septic tank or seepa pit permitted if public sewer is available within 200 feet,) /e 1 :: X { PACKAGE TREATMENT ( ] SEPTIC TANK.[ 5,z ;. `----------- ------------ Liquid Depth _ / .--- Ca pacityr� Q___'_.Type 411---- Material_ - �_ No. Compartments ---- -----•.---• O ,Distance to nearest: Well _160,_ _ _____ _ Foundation - h ----_--___,___ Prop. Line ___ -- - _ " I LEACHING LINE [iR No. of'Lines __ __ �''--____---_ Length of each line____ . ------------- Total Length ------;M D' Box -I------Type Filter Material -_-- Depth. Filter Material _ -------- -------- -------- 7V to �g est: W_eli ----/v�-- ------ Foundation ------ V-'" "-- Property Line. __ ________________•• . I SEEPAGE PIT 'Depth �F-_---- Diameter --- -------- _ Number;7t• --- ----------Rock Filled Yes ❑ No i❑ �� I� Water Table Depth Rock Size �_------------------------- -�4 P ------------------- _.:__�_,.. .� Found Di stance to nearest: Well --- ------------ ; Foy ation ------ Prop. Line ? � . ., - -------------- - REPAIRJADDITION(Prev. Al itation Permit# ------------------------------------ mate } d� . _ ----------•--- Septic Tank (Specify Requirements) ---: ---- -- ------- ------ -------- _ tr Disposal Field (Specfy Requirements) r- �Qu1 " ----- -------- --- ----------- .. .�� 0 -------------------------------- ---- - I If: addition on reb Y ------ ---------------- - --- ------ ----:.- ----- - M ._, (Draw existing and require--------------------------- d verse side) p 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 RLhes and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: i "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 subject to Workman"s Compensation laws of California." } Signed __{. ---- - Owner $Y ------=-=----------- --- �r - I Title --------------------------------- �� =� ------------ (1f other thah owner) FOR DEPARTMENT USE ONLY APPLICATION ACCT=PTEDBY [ -------------- ----- --- DATE t :. BUILDING PERMIT ISSUED ---- -------- - ------ ------- -------DATE -------------•--- -- - --- ---------- ------- -- ------------------ ------------------ ADDITIONAL COMMENTS it —_.__ _ r. �.. �._- ...y._ - ------------- ---------------------------- ------------ --- _ - _ •�• " a Final Inspection by: .=__ :_'" --- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'88 Rev. 5M