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�/ .- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ .. � -------------=--------•-------- -- Permit No: _...------'. "- -- -- --- ----------------------------- --------------- {Complete in Triplicate} Date Issued ----------------- --------------------------------------- This Permit Expires t 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 ADDRESS/LOCATION ._ - -- ---------%{ -- /`/- - --, ---------CENSUS TRACT -------------------------- Owner's Name - - - -- �--��- -- - - ------------------------- - --------------------=---------------------Phone Address ---- ------------------------------------ --------"--. City _+ fes _ --------------- - Contractor's Name ----- `______________________________License Phone - —--------- Installation fInstallation will serve: Residence [Apartment House ❑ Commercial []Trailer Court 'r Motel ❑ Other ------//------------------------------------- 2 Number of living units:-_../----- Number of bedrooms >_Sz�_--___Garbage Grinder��'_�Z Lot Size13 als4l'F----------------- Water Supply: Public System and name ------------------------------------------------------------------------------------------------------------_-Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobeFill Material ____________ If yes, type ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) E NEW INSTALLATION: (No septic tank or.seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK' Size ; `' %- - ---______._ liquid Depth /_____________ ,V~r Capacity of$-fl-------- Type aW/�A7±[7__ Material No.`Compartments ---------------------- Distance-to.neareit: 3Distance-to.neares`t: 'Wel! --_"________._Foundation __ a --_-----__ Prop. Line _f �________ LEACHING LINE ,�Q No. of Lines __-=- _�__-_______ Length of ``each line___ G��________________ Total Length1r.6C�__....___.____ D' Box _ `_W9. __�-�_.�Type Filter Material �,� _ =Depfih Filter Material ��_______ ____________________.___... el p f d Distance to nearest: Well 9-16-7-------------- Foundation ---40-0_________ Property Line SEEPAGE PIT • Depth __ _--_--- Diameter _______ Number _.----f___________________ Rock Filled Yes No Water Table Depth w_____.46,0--1-----------------__________Rock Size _ _ --------------------- Distance to nearest. Well ------ __ __ ____________Foundation ---------- Prop. Line __ _".__..._..__.._. REPAIR/ADDITION(PreO Sanitation Permit#'_______ ________________________ Date __________--------._________,____} SepticTank (Specify Requirements) - ---- -------------------------------------------------------------------------------------------------------------------- rDisposal Field (Specify Requirements) -------------------------- ---------------------------------------------------------------------------------------------------------- s --------------------------:-----------.------------------------------------------ - - - {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 performarice of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed "'Pa�n s". ------ Owner --- --------------- -- ---- BY -- - - -�------------------------------- Title i (If of owner) , FOR DEPA;RTMENI USE ONLY DATE -_"APPLICATION ACCEPTED BY __ _ / l 5-5- -I BUILDING PERMIT ISSUED . -- -----DATE ------------------------------------------- 'ADDITIONAL COMMENTS -------- �.. --- - --- Z-� --- ------ ---------------------------- ------------------------------------------ -------------- ---------------------------------------------------------------------------------------------------------------------------------- Final Inspection b -------------------------------------------------------------------- Date r ------- SAN JOAQUIN LOCAL HEALTH DISTRICT k E. H. 9 1-'b8 Rev. 5M � f