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: -- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _ ..... (Complete in Triplicate) ...S"S ....... This Permit Expires 1 Year from Date Issued Dote Issued k Application is hereby made to the San Joaquin Local Health District for a PP Y q 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 ADDRESS/LOCATIQ - eOe- - --• ,......................CENSUS TRACT .-• - -•:•-•_ i, '- Owner's Name -------- /.� . ...1.- 5--------------------------------•............................Phone . .... Address .................5'.474----._......... ,� 0- City -•--•-. .4 - r o .......--•---- l Contractor's Name ...._. _}I� ......... ....•e -I .#=......--.______.License # d? .1.2 Phone . _i .� .-21, Installation will serve: �' Residence partment House❑ Commercial [-)Trailer Court i Motel ❑Other ............... ....... .. Number of living units:..- __._ Number of bedrooms ._.Garbage Grinder .._..__ ---- Lot Size ._._. _._.arer....S."............. Water Supply: Public System and name ..................................................- ....Private " Character of soil to a depth of 3 feet: Sand[I .Silt❑ Clay eat❑ Sandy Loam ❑ Clay Loam ❑ ; Hard an Adobe Fill Material .._.._._.___ If es, P ❑ Y type --------- •-••------- r (Plot plan, showing size of lot, 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 ... _ __r ...................... Liquid Depth ....//_ .. . Capacity - - - _--• f ype -----------------•,. ateriai...................... No. Compartments � Distance to nearest: Well :_'. .�..�..•..-- ---___Foundation ....� � ___ Prop. Line .jaa +..p I LEACHING LINE No. "of"Lines-,----- -------------- Length of a ceh�Iine= ........... Total Length ....100---........... 0 'D' Box Type Filter Material ._� --. iG+G CDepth Filter Material ._. .-'..................:.............� Distance to nearest: Well -_� .........`r. Foundation ..__ ::fO.--.._..__. Property Lime �� SEEPAGE PIT [ ) Depth .._.� �.___. Diameter ...... Number .._.____ ...,.....Rock Filled Yes No �] Water Table Depth ----14.0... Rock Size .. f _ AO Distance to nearest: Well -------- .................`.'Foundation _. _.__.... Prop. Line � -..._ REPAIR/ADDITION(Prev. Sanitation Permit# --- ---------------•--•--•---••----...---_-:- Date ._.:.............................:j SepticTank (Specify,Requirements) ------- ..................................... ....................................•-.................................................. ----- s Disposal Field (Specify Requirements) ............................................. ---------------•--•---------------------- ----------------------------------------.--.-----------•----•------------------------------------._.....--_._...---••---•----•--....-------......_......_ ---------------------------- ..._•----•--- -----1•---•_....._.:.--•--------------••---------------------•---.:.--•-••-•---•-•- ..................................... (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 Mon- sed agents signature certifies the following: "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." Signed ---- y''' % Owner ---•----- ------ By ...............i - - • •-- --- - -------• - -------------•...... Title .... _ � '_... �# •P-•e••6" : (if of than owner] r / �-� FOR DEPARTM> T USE ONLY - APPLICATION ACCEPTED BY -- - .............................................. DATE ...6 ................ BUILDINGPERMIT ISSUED ............ ......... -----------------------------------:...........--.................DATE ....................-...................... ADDITIONAL COMMENTS ----- .......................•••------•--•-...... - .........................---.-.....................•-............... ........................................................:..:....................................................... ..................•.............•......... . Final Inspection by: :. :. _ _. . _ ----Date SAN JOAQUIN LOCAL HEALTH DISTRICT t- E. H.1.3 241-'66 Rev, 5M 7172 3 M '