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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT' ---------------------- --------------------------------- Permit No. a.-�� i (Complete in Triplicate) ---------- ------------------------------------------ Date Issued _5F`/1;Zy ` . w ----------------""--------------------------------------- a 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 d.escr_ibed,.Thi application is ode iri compliance with County Ordinance No. 549 and existing R !es an Reg lotions:_ / - 17 i JOB ADDRESS/LOCAT N - ----$S`_ /r!_ / ----e--__S-;Z/1a-- —CEf SUS R �------------ ---- ------ Owner's Name --�."-� ,�---"- �J�_�!->��-- --------/- -•------------------------------�---------------- -_Phone-----�---�----�------ Address -------- .01----- -/"/��y + + City _-- /-go " --------------- i Contractor's Name ------- ""' i/ �� ------------ License # - Phone Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court 0 s k I Motel F-1 Other -------------------------------------------- , f Number of living units:---_/r___._ Number of bedrooms -------Garbage Grinder,4/,O-._ Lot Size ---------- Water Supply: Public System and name ________ Private - -/--------- ' Character of soil to a depth of 3 feet: - Sand Silt Cldy ❑ Peat❑ Sandy Loam ❑ Clay Loam.E] Hardpan ❑ Adobe.!] 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.) (� L . NEW INSTALLATION.- (No septic tank or seepage pit permitted if public sgwer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size__ . _ - - _._._ _._-___ Liquid Depth _- �._._.____,___" Capacity/44_ _ Type Materia!_ iVo. Compartments ___ '_____...._. Distance to nearest: Well _---____________________ Foundation A ------ Line �_..______ - LEACHING LINE No. of Lines ---.7--------------- Length of each line _45�9------------- Total Length � °_.�_______._. w 'D' Box . /-� F Type Filter Material 1- Depth Filter Material __ _f�------------------ { ro A._y, --------- �..�• ---- -`" '' - P rty SEEPAGE PIT [ ] Depth ----------___________ Diameter ---_____________ Number _.-_------------------------- Rock Filled Yes ❑ No i❑ Water Table :Depth ------------------------------------------------Rock Size ------ --------------------•---- Distance to nearest: Well ----------------------------------"...-.Foundation -------------------- Prop. Line ----------.-- ........ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------.__.__________________.___) SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------- -------------..__-..----------------•---------- Disposal Field (Specify Requirements) ___________ _ _ ___ ----------------------------------------- • s - - - ---------------------------------------------------------------- ---- --- I ----------------------------------------- -------------------------------------------------------------- -----------------------------------------------'--------- �. (Draw existing and required addition on reverse sidJ 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 Regulationssof-the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: r "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 Co nsati.on laws of California." r J Signed ? ........ - - - - ------ ------------ ----=< -`--- Owner BY -------------- ------------------ 7ifile 4 than owner) . l �f f _ t FOR DEPARTMENT USE`ONLY APPLICATION ACCEPTED BYf -- ------------=-------------° '---------------------------- . DATE- BUILDING PERMIT ISSUED f` - ------------ ------------DATE -----ir'-----•------------------------•-- ADDITIONALCOMMENTS `=• -------s------------- ------------------------------------------------------------------- ---------------------- ---------------- --•---•----------- E1. ________________________________________________________________________ ______________________________.__________"___------___--____-_-_________________________________________.. __--_________-_______ i I _____________________________________"__--- - _I"�-_ �_________ _ ____________________ _______-_____-___________________________________________________/___�^_.__�__..__________________ ____ _____ ________ ____________________________________________________ _________________ _ Final Inspection by: _ �� ---------------------------:--------- = ' Date ----------------- t ' --------- -------- (f I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 T-'68 Rev.5M. ?