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FOR OFFICE USE: - LLThis ATION FOR SANITATION PERMIT r •--------------------- - - Permit No. ��_ ((Complete in Triplicate) x --------------------------- rmit Expires 1 Year From Date Issued Date�lssued _ _=�...`7l Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made co nce with County Ordinance No. 549 and existing Mules and Regulations: JOB ADDRESS/LOCAT O fi ----- .'_.CENSUS TRACT ---------------------- Owner's Name -- --- � ----- - - K � ------- < Pho e 7 cit Address -- -- - --- --------------------- Y - �----��---�------P-h--o--n--e--�-�--�------------_--�-------�-�---.-�---�---- License --- Contractor's Name ----- ___� - - _ -------------- Installation will serve: 1 Residence ment House❑ Commercial :❑Trailer Court ;❑ r Motel ❑ Other •------------------------------------------- -2- ------------ ---------------------------- y Number of living units:--__ - Number of bedroo `__Garbage/Grier. _ "_- Lot Size __ ` _ ___._..___ , , Water Supply: Public System and name ---------- y/ -------------------------Private ❑ Character of soil to a depth o0 feet: Sand'❑ Silt❑ Elay Peat❑ Sandy Loam ❑ Clay Loam ❑ 3 Hardpan ❑ Adobe Fill Material _ If yes,type ---------_______________ (Plot plan, showing size of jot, location 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 available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size --------------,. Liquid Depth ------ ----------- Capacity _1 Type Ae��Mater`i r No. Compartments �_____________ ` Distance to nearest: Well ------:--�'_�_.-_-"_____Found'ation �--_---------- Prop. Line _SCf___________ ` J __-____ Length of each ~line____ _ C�---------�_ Total Length LEACHING LINE No. of Lines _____________ -r D' Box _illu Type Filter Material /�_-= ______ epth Filter Material //________________-_________-_._... J y � Distance to nearest: Well ___'-` —------ Foundation --------- Property Line, --- ____ // ______ Rock Filled Yes 00 SEEPAGE PIT [r Depth � !__._____ Diameter _ ------_ Number _._.__/---____-- ff � Water Table Depth ------- -------------------------------- Size r _/l_: r -------- ,- -- Distance to nearest: Well ----_-!7-7�--------------'.-----Foundation /---_._-_ Prop. Line -IS___-__--__-.___-_- i REPAIR/ADDITION(Prev. Sanitation Permits_ :,:._ _ -----------1-o- Date _________.r________________________) I Septic Tank (Specify Requirements) --1-------------------------------------------------------------------- '-'-----:__. --------------------- -•-- k ! Disposal Field (Specify Requirements) ------------------------------------------------------------------- ------- -- ---------------------------------------------------- I -------------- ---------------- ------------------------------------------------------------------------------------------------------- _4--------------------------------------I------------------------ -------------- -- ----------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ ------ (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: 3 "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become'subject to Workman's Compensation laws of California." s _ y Signed ......... -----. { -------- ------------------------------------------------ Owner q �,� % By -------------- -------- k - `:_------------------------- Title -- 4-C1--.ke-�--------- ------------------------- lf "er than owner) } FOR DEPARTMENT USE ONLY f' APPLICATION ACCEPTED BY ------- --- - ------------------------------------ DATE -- ----If- ------------_=--------- BUILDING PERMIT ISSUED --- -------------------------------------------- --------------------------------------------------------DATE --- ------------------------------------- ADDITIONAL COMMENTS3-�` - -- -- -------------------------------------- --------------------------- ?{ -� - -- ----- ----- -AV_ -------- -- - - - --------------------------------------------------------------- _______________ _______________ ____ ___�.______.____---_8 _ J - --_-__ __ _ Final Inspection by Date - - -- -----=- - - - ----------- ----- - ---------- - -------- ---- ------------ ISAN JOAClUI LOCAL .HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M '' `�