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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT s Permit No. ..................... ..................................................... (Complete in Triplicate) ............................................... Date IssuedU- ;1-16 - ....a......... This Permit Expires li 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 mode In compliance with County Ordinance No. 549 and existing Rules and Regulations / .. CENSUS TRACT ....................•---•• I JOB ADDRESS/LOCATION ....... �.__. .. •..................... . ... Owner's Name1.�d � ,4�'..(J :.. ...................:::...............Phone .�� Address ...... ......... ° ----------••--•------ City ,�r.9Q ................ ............................... Contractor's Name ../ .. i�!4��rl�----------• ------- License #a $ o .. Phone Installation will serve: Residence [W Apartment House'0 Commercial oTrailer Court 0 --•--. .--Motel-E]Other_ --:.---.-_ .---------== �,� .,.. Number of living units:_-- -- Number of bedrooms ,�____---Garbage Grinder _._..._-..__ tot Size . = Water Supply: Public System and name ---------- .. f. dr1._.� Private❑ s "L `} ...----•- -•- Peat(] Sand Character of soil to a depth of 3 feet: Sand'❑ Silt(D Clay ❑ Y Loom Clay Loam [] Hardpan o.._Adobe o Fill Material ........ If yes,type ., - - {Plot plan, showing size of lot, location of system in relation tor wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: +N1No•,sep#ic tank or seepage pit permitted if public sewer is available within 200 feet,) t PACKAGE TREATMENT[-] SEPTICTANK I ] 'Size... _--.-----._-- - - _Liquid Depth -----,•..............•- .x I . Type Compartments .................. �� •Capacity -----------•- -----_ .-.............. ---- Material------------- - 1 � Yrk Distance to nearest: Well ---------- ...................... -----------------..... Prop. Line ---•,---...----••---•1 Total Length . Length of each line..----••---------•---•-•.. . ��` LEACHING tIN..E { j ...No. of Lines ----•-----•--_-----••-• g ..... ..................... D'86x. -- Type irilt_er Material ...---------"`--bepth Filter Material ....................:. .......... Foundation ........................ Property Line ...::---........I.. Distance to nearest: Well -!--.77=_-.... "' SEEPAGE -- } . - iameter ...... .. _. ..--- Number - ..--------_------ --- Rock Filled Yes��[3 Na PIT Depth, __............... D 'Water Table Depth --------------•---_---- .......................Rock Size ___..................:..... ,) ' ..Foundation ------ p• -•-• Distance°to.nearest.. Well ---------------------------- Pro Line ...._---•_--- ! N REPAIR/ADDITION(Prev. Sanitation.Permit# ----------------------- .................... Date ........................•-......... 1 r .......... .......... -• .... ........................... to Septic Tank [Specifjr,Requirements) --------..............................•--•--••-......------------•-- . � .... I , 4/9 �/ .. Disposal Field Specify'Requirements);.--,. /-.. �.. . . s lDraw existing and rea re addition an reverse side} ` litation and that the work will be done in accordance with San Joaqui� thereby certify that t have prepared this app, , County Ordinances, State Carers, and Rules and Regulations of the Son Joaquin Local Health District.-Horne owner or lieen- sed agents si§nature certifies the following:? .� "I certify that in the;perforntance.of the work For which this permit�Is�issL; ,-I,shall.not employ any person In such manner as to become subje o orkman's Compensation laws of California." Signed ... Owner By --• --•• --------------------•-------------------...------_-_,Title`- -- .................................------------ .... er than (If other . a awned w_ Y � FOR DEPARTMENT USE ONLY y [ _ __ DATE" �..- ..�. APPLICATION ACCEPTED BY .. ..... . . 1.6.- ` BUILDING PERMIT ISSUED ... - - ------- - -DATE ADDITIONAL COMMENTS ------------- ----------------•-------•----- --------------•--------- ---- - -- .... ------------------.------------------.......... k ---------------•-----------------------------------------•--------- ------•----------•----------------- -- •----- ------ -------- --------------_----------- final Inspection bY- ---------------- ••- ......Date .....�b-....fin'_. �� -------- .........................•--...................----••--... i Elf 13 24 1-6 v. 51 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M