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{ FOR OFFICE USE: 1=��p // 3 I M APPLICATION FOR SANITATION PERMIT = i --- ----- 4;:7 --------- (Complete in Triplicate) - Permit No- ------------- =------------------------------------ --------- ------------- This Permit Expires 1 Year From Date Issued 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 46 S'6 J { - -------- -� y✓ ----- _ ar S ENSUS TRACT ------------------ Owner's Name -- ----- L _ /� - - --- ------------------ - -----------•---- ------ -----Phone Address 14 9- ---- Q, Cit ---- - -- -- - Contractor's Name '� � * r` i. License # -- Phone � o �i� ---- Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑Other ----------------- -------------------------- Number of living units:.-_- Number of be ooms . ____ or a e Grinder ------------ Lot Size o ! Q Water Supply: Public System and name _- -- Private -------- ----------------------------------------------- Character of sail to a depth of 3 feet: Sand'❑ Silt Clay Peat❑ Sandy Loam -❑ Clay-Loam Hardpan ❑ Adobe Fill 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.) NEW INSTALLATION- (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �q PACKAGE TREATMENT f ] SEPTIC TANK. Size-445el-_�_ _._ ---------_--_- Liquid .Depth -------- 1 Capacity 1-2.-C> b1 )0_-_- Type' _--------- _ MaterialP - No. Compartments -�, ---- •- _ Distance to nearest: Well _- _-Foundation -- - _�__---_ Prop. Line __---- LEACHING LINENo. of Linesg --= -------------------- Length of each line---�--E7 ------- .------ Total Length -----�--E�_...------_--- b' Box-------------- Type Filter Ma al& - Depth Filter Material _-_�-. __-_--_--_._ _ --------- -------------- Distance to nearest: Wel _____--- Foun anon ��_r__---------_ Property Line _-___- r -- ------------- SEEPAGE PIT Depth (>)_C.- Diameter ��-'± Number f------------ -- Rock Filled Yes JK No 0 Water Table Depth ------1-0 r ------ Rock Size Distance to nearest: Well __- ------ - ------------ --Foundation - 0-------. Prop. Line --�--------- REPAIR/ADDITION(Prev.'Sanitation Permit _-'t------ --------------------------- Date ----------- ------- Septic Tank (Specify Requirements) __-_------------------------��_--__-_ Disposal Field (Specify Requirements) - _--- t/iaA---------------------------------------------------- -------- ---------- - ------ ----------- ------------------------------------------------- \. (Draw existing and required addition on reverse side) I hereby certify that ],-have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Sate 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 beta bject o Workman's Compensatilaws of California." Signe �d By ----------------------------- -- -------------- ------------- Title ------------------------------------------- { (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED, BY ------- frLC DATE - _I/ _.�-6 BUILDING PERMIT ISSUEDADDITIODATE ---------------------------------- - - NAL COMMENTS ____________________ ------------------------------------------------------------------------------------------------------------- ----------------------------------------------- -------------- ------- -------------------------- - -- --------- ------- - -- ----------------- ma Inspection by: • ---------Datejb --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M•