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FOR OFFICE USE: •- ;, .; _ APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ______^__.________- -------------------- ------------------------------------ f This Permit Expires 1 Year From Date Issued - Date Issued 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 in compliance with County Ordinance No. 549 and existingRulesRules and Regulations: JOB ADDRESS/LOCATION.,.SE��._,C-o-/�-tyr�----��of r�-Ie_ __.. _F �'�LCENSus�RAC / - - Owner's Name ---X-1---`I-0-11------------------------------------------------------ ----------------------------- --------Phone. i��- 9S� Address .- -9----c Q-------9U_11y�41ZCity Q CI ---- Contractor's Name .-- --.-- " 1 �21/- ------------- -.-:--------License # 1_� Phone - d`ra- - y Installation will serve: Residence Apartment House,[:] Commercial:❑Trailer Court ❑ Motel ❑Other -------------------------------------------- Number of living units:--- Number of bedrooms _______Garbage Grinder ------------ Lot Size ________________________________._________ Water Supply: Public System and name -------------------------------------------------------------- ------------------------- Private . - w, Character of soil to a depth of 3 feet: Sand'N Silt❑ Clay ❑ Peat❑ Sandy Loam lay Loam T1 Hardpan ❑ Adobe ❑ Fill Material _1V0s_ If yes,-type ________________________J _ r (Pl'ot 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,) 1 ' PACKAGE TREATMENT { ] SEPTIC TANK�4f Size__S _Y!__�---X__./1_____-__--_-- Liquid Depth ��_____-._______ ��L Capacity lSd d------ TypeMaterial' No. Compartments ___fes______________ v Distance to nearest: Well -----6-0 -------------------Foundation ----------- Prop. Line _____%�---___-_-_ LEACHING LINE [ ] No. of Lines ____ ____._ g g a __--______-- Length of each line---b-a_______________ Total Length __1__0'.!i�- .......... 'D' Box _ _ Type Filter Material _--Depth f=ilter Material -----1.9-_____________________ ________ � � 0-- � ___6 Distance to nearest: Well __.__-�_______ ______ Foundation __,--1 Property Line. __.______._..:.... SEEPAGE PIT Depth Diameter __ Number .-- ------------ Rock Filled Yes 0 Na .i❑ ' Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well-----------------------------------------Foundation -------------- ----- Prop. Line ------------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------] Septic Tank (Specify Requirements) -------------------------------------------------------------l i ' Disposal Field (Specify Requirements) t --------------- -------------------------------------- ------------------------ ------------------------------------------„ - ,------------------ --------------------------v------------------------ ---- ----- -- ------------ - --------------------------------------------------------------------------------------- ----------------------- _ �- (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: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become Wed to&WVVrkmon's Compensation laws of California.” Signed6? Q,. ------------ Owner By ------- `-------------------------------=- -------------------------------------------------- Title ----------- ----- ------------- ---------------------------------------- (If other than owne FOR DEPARTMENT USE ONLY APPLICATION gYR - i --------- BUILDING PERMIT ISSUED 1ELL _ DATE ------------------------------------------- ADDITIONAL l 'ADDITIONAL COMMENTS ---------------------------------------------------------- - -----------•-------------------------------- ----- ----- ----- ------------------------------------------------------------------- -------------------------------------------------------- ---- ---- --------------------------------- -- ----- - --- -- ---------------------------------------------------------------- ---------------------------- Final Inspection by '- - ------------------ ------------------------------------- ----.Date -I�= 4 - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M