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FOR OFFICE USE: _. APPLICATION FOR SANITATION PERMIT �. ---------_-- �— Permit No. _4 --------===----- (Complete in Triplicate) ----------------------------------------------- Dote ------------------ ------------------ Date Issued - -. `j _________________________________________________________ This Permit Expires ] 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: JOB ADDRESSA TION . �, C� I�- ----------------------- -CENSUS TRACT ---S-----�----- Owner's Name _� 61._Ql'V ---- -- --Pa. ?a A5.A0 C� Phone �a G 1C�1 ----------- Cit /-if Gr Address _. __-________,�_ --a p1 �y f �,.��yy ' /`t " / �----------------------------.License #e2 y- I�R____ Phone d:PPS7� --d/ Contractor's Name -_�,.// --- Installation will serve: / Residence ]Apartment House❑ Co mercial ❑Trailer Court i❑ �r Motet ❑ Other -__U61a Number of living units------------- Number of bedrooms --- - ------Gar bage rinder ___________ Lot Size ___ �`"`- ------- . Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sond'® Silt❑ Gay ❑ Peat❑ Sandy Loam lay Loam.0 Hardpan E] Adobe-E] Fill Material _, _ ilf'ye;type --------- k__ -_r - • _-_ :� "-r ✓ .7 (PI'ot plan, showing size of lot, location"of,,system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No sep a[ tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK![ ] 1 Size------------------------------------------------ Liquid Depth -------------------- 6\ Type -------------------- Material---------------------- No. Compartments -----------------=---- }� tiy. J Distance' to nearest: Well ----____---__-____________________Foundation ---------- ----------- Prop. Line _-_-__________________ LEACHING LINE [ ] No, of Limes ________________________ Length.of-each line---------------------------- Total Length ------.--------._______.____ C 'D' Box ------------ Type Filter Material __ ________________Depth Filter Material -------------------..-._........_----------- i Distance to nearest: Well _______________________ Foundation ------------------------ Property Line _-___._ ...... SEEPAGE PIT [ ] Depth ___________________ "} s� Number ------------------------- _ Rock Filled'tiYes E] No i❑ _ Di/arnete� ---------- ____ -----..Rock Size ------------------- " Water Table Depth/ ----- ----;;�,�=;:------------•- ------------- 1 Distance to nearest: Well - - � i--------------------------Foundation -------------------- Prop. Line ------.--------------- REPAIR/ADDITION(Prev. Sanitation P,e'rmit�#Y�—____________________-_�__:�___-- Date---------�_..,--_-----.-.__- f f Septic Tank (Specify Requirements) -----------------------r'F --------------- -- \------------------------------- �- Xi- •�' Disposal Fiel (Specify Requirements) - -- --------- 53;"� 1 t -- ------- � - x -------------------------------------------------- ------ - ------------------ = - ------ ------ -------------------------------------------------------- ------t . i Ir(Draw 6i sting Tindlequired)6ddit+a►a-•on reverse side)---,�.l t : I 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 lcen- sed;agents signature certifies•the followingr•-w,.--- ,..._. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such mariner as to become subjec to Wor an's Compensation,Id, _,of Calr ornin ;' Signed' = = =�= _=. == ......+'. J Ownerµ BY ------ -- --- -- -------------- ---------------- ------------- ------- Title ----- ------ ---- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ----------------------------------------------------------- DATE ----- ---------- BUILDING PERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE --------------- ADDITIONALCOMMENTS ------------- ---------------------------------------------------------------------------------------------------------------------=-------- ------•--------- - ------------------------------------------- ---- - _ r - ------ ------- ------ - --------------------------------------------------------- Final ---------------------- ----- ---------- - ----- ----Final Inspecti �.' - ----- ---- ----- -- -- -=----------------- --------------------Date =-- --- -- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M. i