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FOR OFFICE i,slr: APPLICATION FOR SANITATION PERMIT .......... ........... .._ --• ........... Permit No. .................... w(Cofflplete•in_7riplicatol Dote Issued . .... �.. ......•-•.. ........................•-• -•---••-•---- This Persttit Expires ] Year From Date Issued . Application is hereby mode 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: j 77 Boa ADD ss/Lo oN .�. .......CENs ..••--•..............•••......--••••••--•• ..--•- .......................... iIs TRACT .......................... Owner's Name _.. ................................ ..--•.............Phone ... = •-----•••... ........ .... . . Address 9 ?� ....City =....: -----........ Contractor's Name ----- -_ •. -- � . -- •.. . ...... ...... .......License Phone ....... ._................_. Installation will serve: Residence Apartment House 0 Commercial QTrailer Court 0 � I `!Note) ❑Cttleer k ...........:..:.. • _1 Number of living units:...... Number of bedrooms .... .-_Garbage Grinder .... Lot Size ------- Supply: Public System and naive ............. .... ...--..."..... ....... ....................... .....-:.. r v _ --... P i ate Character of sail to a depth of 3 feet: Sand Qt Silt Q Clay Q-,Peat Q Sandy Loam Clay Loom Q - s Hardpan 0 Adobe Q,Fiii Material ....-_......If yes,type ............... ............ € (Plot pian,- showing size of lot, location of system in relation to wells; buildings, etc. must be placed on- reverse slde.f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK ] Size__ .............................. ...... Liquid Depth _......_._._........__..._J Capacity }:........... Type -••••-...._ Material. .......... Na. Compartments - ..........u, Distance.to nearest: Well .....................................Foundation ...................... Prop. Line .................. LEACHING LINT: { ]' No. of Lines ........................ Length of-each line............................ Total Length ._......___.___....._........L • f 'D' Box ... ------. Type Filter Muteiial ...Depth .Filter Material ............. -••-'-•--- -- Distance to nearest: Well ........................ Foundation ............... Property Line :_.......... .......... SEEPAGE PIT ( j Depth :-_.-.4.............. Diameter .................. Number _:__..........:.............. Rock Filled Yes 0 No Q Water Table Depth .. Rock Size Distance to nearest Well .............................Foundation .................... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit 51 s ---------------------------------'--•---.... Date .---=---•-=--...-----..:......----1 ., .::.. . ..... ...........:.. ............. .............. --- Septic Tank (Specify Requirements) .!::....:-•------•--•----• �---•--------•--• --•--------- -- .................. Disposal Field (Specify Requirements) ----- -•--•-•----•..........................:•--------•----... --._.......--•• --- ............. •-•--•------ .. , ^� ---------- ..---------------= ---•-. ...... . .-- - -� C ... ....•... F ,_------------------------------------------•---••-•---- - .._.: Y (Draw existing and-required addition on reverse side) I hereby certify that 1 have prepared this.application and that the work will be clone In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health.flistrict.'Home owner or licen- sed agents signature certifies the following: i Issued, 1 shall not employ an person In such manner certify that in the Merfsrmwnce of the work for'which this permit is s M y Y w _ asCalifornia." to become subject to Workman's Compensation laws of California. Signed ................................ •-- x. ----- Owner ` � _ Jitl . -------------------- •-•------ e (Ifother than owner) , I OR UPARTMENT USE ONLY APPLICATION ACCEPTED BY_.._� :..r3'-- -- ----------•--_ -•---•---------------- --------.,DATE". ..�Z .------------------_------ BUILDING PERMIT ISSUED _---- •------ + ---------•-'.. .................DATE . •-- _-------.... ADDITIONALCOMMENTS --------------------------------------------------___---------------------------------------------- ------------ ---------------- ..................... ---------------------------------- ------------------------------------- ------•--------------------------------------•------------------- .....-......................._........................... ••------- = ---------------------------------1--------------- -----------......._.. -------------- .............................------------.........................................._-...... - Finai Inspection by. _..:.. - Date .e/-Ph ..' ......................... . i ' EH 13 24 1-68 ilev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M