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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT I _:._ «_ ` � -' rm►tN � . �--•-��:- ..^ •�-�- ��"°"'-"'""°(Complete in Tripli`af-e1 -�� - - Date Issued This permit Expires 1 Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Or'a:ce No. 549 and existing Rules a d egt atltin�s � r ]] tl Q-r-nom f� �- u' CKVISUS TRACT ---------------.------- - JOB ADDRESS/LOCATION .I�'-�'�_� -- � � � - � - j•_• -----------•------ hone Owner's Name , � . ` - P -••- -� _ C y ss - 2A / -- -------------------- -�' it� Address ---- ------ � �-=-------- _ .. - --------- - - - -- Contractor's Name / 0-'' Licensb # - _r/- _-a_5� 4hone '.. Installation will serve: Residence partment House❑ Commerc ul❑Trailer Court ❑ 'Motel ❑Other ----------------------------------- _Ode ---------------------------- --- Number of living units:------ ____ Number of;,bedrooms`j_____----Garbage.Gri der.'_f_ti='.___ Lot Size �- - r --- r -------Privat Water Supply: Public System and name.------------ ------'---��R=-`;---- ----- ---•----•- ------------------------• ----• - . Character of soil to a depth of 3 feet: Sand,❑ Silt o Clay ® Peafi-❑ Sandy Loam -❑ Clay Loam .04. + M - _ - _ _� -�-Hardpan❑—Ado e + FiII aterial; yes type-- - ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on'reverseside.j - NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewef i?available withirl 200 feet,) f t PACKAGE TREATMENT [ ] SEPTIC TANK �pSize____=1IVU�. ._ - ,-- ---------- Liquid Depth _'r�,l?._ f. a YP t-�st 4� j i g Type _7 ---- t Material_ �'.�_hj j: ,.�No. Compartments ----------• '-- -' '�f Capacity a - / 0- Prop. Line -l�__--- ;.... Distance to nearest: Well -----6_v)______________ T ti,n _ _ p ..' _ ____ Length of each line.... a _____ Total Length � yp.------# ' LEACHING LINE -'� No. of Lines '----- -- - ------"- D' Box ___ � Type Filter Material -- �y__i� pi {_f Material --_ -1_9_11- ------------------- -------- 1 f _De,�h� ��e M_�,pro�erty Line- �� -------------•- pistance to nearest: Well __ __________________ Foundation. _ ---___._-_�--__-- , Number .________ ________ ...__. hock Filled Yes ❑ No i❑ SEEPAGE PIT ( � Depth ----------'--------- Diameter ----------- - -- •3r � Water Table Depth ------------------------------------------------Rock Size ------.------------------------ E Distance to_nea_rest_Weli_._„--:-„_:<_-•------•-----••-,Foundpt1onr--t-r------ -------.,.Prop__Line._.... �x._....._ f REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------- ---- Date ----------------------------------1 a Septic Tank (Specify Requirements) ------------------------------- -----------------------------1.-----------------•-----_ pisposal Field (Specify Requirements) ------------- - ---- -------------------- ----------------•---•-------------------------------------------- ` ---- ----- ------ ----------------------------------- ------------- ----- ----- �-�-- --- 1 = q --- `(Drav`7`extsti and-re• iiired`additian on reverse-si e l thereby certify that 1 have prepared this application and th t_s°the work will be done in accordance with San Joaquin I County Ordinances, State Laws, and Rules -and Regulations the San Joaquin Local Health District. Home owner or hcen- 1 sed agents signature certifies the following: "I certify that in the performance of the work for which is permit,is issued, I shall not employ any person in such manner as-to become subject to Workman's Compensation law of California." Signed --------------------- ----------------------------------/_ Owner --------------- -------------------- BY ------------------------------- k/► ------ Title � . (If other th caner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- -- ----- 'S---------- ------- ------------"------------------------------ DATE p_8� BUILDING PERMIT ISSUED ----------------- DATE -------------------------------------------------------- A DDITIONAL COMMENTS --------------------------------- -------------------------- -- - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- -------•------------------------- Dateb-- ~''��---------------------- Final Inspection by: ---- ------------------------- ! SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M