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M FOR OFFICE USE: APPLICATION APPLICATION FOR SANITATION PERMIT (� J C� Permit No. S_r`-- / --------------------- --_ •-- ------------------ (Complete in Triplicate) - ' ---- Date Issued i 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations:gulations: JOB ADDRESS/LOCATION --- - = -- ,------- lj�[ ' C 1------� � N CENSUS TRACT --------------•----------• I -fz TG�L - ---------------------------- ----- --------------Phone Q1'.1 Owner's Name _-_ - �� ------------ 7e- Cil G ?�--- ----------------- --------------_---- Address .----- Y = --------- n l l Contractor's Name ,1 _ Graf ----------------`------.License # r�J _ Phone I Installation will serve: Residence 'Apartment House❑ Commercial ❑Trailer Court ❑ Motel_❑Other :_ ----------_------_--- a -•--_� ._ Number of living units:____:::_ Number 'of-b9diooms -_ Garbag�`Grinder _ ori Lot Size 'n-�- -- - f Supply: y : .e ---;--- ❑ Y �- Private,] Water Su I Public System and ^ --5i{t�--------_Clay--❑--- Peat------- -Sand---Loam-�--- f i f Character of soil to a depth of 3`' ❑ ❑ Clay Loam ❑ ;,,,_,Hardpan.Q_ Adobe-E].-..Fill Material.:.___---_--- If yes,�type--------------------------" r i t 1 (Plot plan, showing size of lot, lactation 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 availableL;thin uld200 Defle#,) t 4 1 I Size- -------- � q= p -��-------- PACKAGE TREATMENT [.I SEPTfC-TANK:[ ] ' 1 ' i� G; Material--------------------s_ -No. Compartments _____.,_-- -.! 6 Capacity ---- TYp - 4- / f. Foundation 3----:--- ---- Prop. Line -- k Distance toy nearest: Well ___-� --------- LEACHING.LINE [ ] No. of Line s -- -------------- Length of each line--- '- .. Total I ength __- ..---------.. t a 1 i I , y 'D' Box ---- Type Filter Material ,/ -Depth Filter Ma'teri'al .__-_ ,t------------------- �� _ - Property Line -_ ?? ------------- `lY'•� Foundation I : D_istanceto dearest: Well __ -- ------ Rock Filled Yeso �❑ r ?`--------------- -Ro k,Siz-----^ _ } [ � Depth --------------- ---- Diameter )Number .- ! - r r 4 Water Table Depth � -� --------- i ------ . ----- -- �. iDisfiance to nearest. Well --------------------------- -----------Fours'dation---^^-'='�-------------Prop. Line ------ ------ f •- fDate H REPAIR/ADDITION(Prev.lSanitation Permit# ----------------------------------:---- -- Date ____._..___---- �) t ----------------------- Septic -t Tank {Specify Requirements) -------- -------------------------------------------i-----------------------------_-------------- ... z t i Disposal Field (Specify Requirements) ------- -------------------------- ---------- --------- + I I ----- ------------------- ---- ------ - ----------- ------------------------------- ------------------- I ------------------ - - - j (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulation`s of-the-San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: ) # l "I certify that in the performance of the work for which this permit is issued; I shall not employ any person in such manner Compe-n---s-a--t-i-o-n----l-a--w---s--o--f--California.'?to become subje o rkmaOw�nerSigned ---- ------;----' ---------------r-' ------�-L- 'h�Ill BYTitle ------ -' (If other than owner) FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY -------- -----------------------------=-- DATE 2 r r ------- BUILDING PERMIT ISSUED -------------------- ----------------DATE '-------------------------------------- ADDITIONALCOMMENTS ---------------------------------•--------------------- ----------------------------•--------------------------------------------------- - - -- --------- - -----•--- .w_ - — --------------- -- ------------ Fina! Ins_ection b ------ -------------------------------------------------------- -------- -- - - ------------------- ate ----- `, SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M