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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ----------------------------- Permit No: (Complete in Triplicate) ------- This Permit Expires 1 Year From Date Issued Date Issued - a_�_ �'✓ Application is hereby made tote San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .----.. _ �-----503------O 4Al Y_01_- 0141 t!!f_ -_CENSUS TRACT -------------------------- Owner's Name t I � ff y�� ----- ------- "S� t'--------V-, ��! x' ----j------------- --- --------:------------------.Phone - ------------------------ Address -----A.��-300------:5-a- - .�__C ' ! -- --y-, 6_W_ISGt�__. City g~/ F/w 6 ---------------------------------------------------- Contractor's Name ---,G=- _.--,411/_r/;?_0..V -C�-- o--------------License #, _✓r _6_- Phone _ 3_-�_:Z.l Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court i❑ Motel [!I Other ---------m9-k7;_4---ROM OR- Number of living units:------- _ Number of bedrooms ________Garbage Grinder ----------.- Lot Size ____________________________________________ Water Supply: Public System and name ----------- f-------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ ! Silt❑ Clay ❑ Peat❑ _Sandy„Loam,-❑ ._ Clay Loam .� 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.) f NEW INSTALLATION: (No septic tank or seepage pit permitted ��iff public sewer is available within 200 feet,)tt// PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size.T1 _/_�_________ ____________ Liquid Depth __/____7____--.__,_____ Capacity ____ _ ------ Type �P�`d- Material__. __ No. Compartments �aaa c�� Distance to nearest: Well 1 4U..r__.Foundation _e�a_ ----------- Prop. Line LEACHING LINE No. of Lines Length of each line_ r [ l -- dam--_ - 9 �a------------- Total Length -�-��--�--------------- 'D' Box ___ Type Filter Material _ ___ b� epth Filter Material ----- _____._ a� ---------------------- Distance to nearest: Well __!�0_�_______ Foundation _A16_.V----------- Property Line 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 s# -------------------------------------------- Date __________________________________) Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------:------------------------------------- -------- Disposal Field (Specify Requirements) ---------------------------------------------------- -------------------------- ------------------------------- -------------------------------------- --------- ---- (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. 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 as to become subject to Workman's Compensation laws of California." Signed ----- --'�- - --/�_/ /1-- -- -------�--`-��------------------- -- Owner �. BY ------------------ Title (If other than FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ---_ DATE ---------------------------------------- ---------------------------------------------------- --- BUILDINGPERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE ---------------------------------------•--- ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------------------------•---------------- -- ------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- -- --------------------------------------------------------------------- -------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- - - - - -------- - - Final Inspection bY= ---------------------------------------------------------------------------- Date _... SAN JOAQUIN LOCAL HEA DISTRICT ��E. H. 9 1-'68 Rev. 5M �