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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------- ------------------------------------ - (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 per to construct and install the work herein described. This application is made in i'n compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-----f0.<?___��--,-- ----fes � ---------------------CENSUS TRACT --------------.-----____-- Owner's Nome�12�+ X S I t 5 ---------- �• ------------Phone ---------------------------------- � -------------------------- Address ---------------------- -------- 421------4.-------- i City ------------ k--------------------------------------------.__............ Contractor's Name �c�� c S ��ouse,E] ----------------- License # --4./: - a_Phone ---------------------- Installation ._�J7- Installation will serve: Residence Commercial :❑Trailer Court ',❑ Motel ❑Other ---------------------------------------- -- Number of living units;---1------ Number of bedroon�______Garbage Grinder _�fQ�_ Lot Size --6_f�C_-Y ______________ Water Supply: PubliicSystem and name ----------------------`------------------------------------------------------------------ -------------Private r Character of soil to a:depth of 3 feet: Sand'❑ Silt,❑ Cl y E--]' Peat E] Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe' Fill Material ------ If If yes,type ______-" _________________ i (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 1 F _Q. tSize-'�- -- _� _ Liquid Depth -- -- -- ------- Capacity --_.-- __--- Ca acit p y --- ----- ---------- Type -�;w--- Moteria __ _ - �A No. Compartments --- ---..---. C), LEACHING LINE No.Distance 1_i Jo. nearest Well ____— ---------------------_ Foundation s_/_____-____-- Prop. Line _S-_�_____-____ \ i I, g -ofY each line• (_ --� Total Length _�.�.�--------_--- I)'.Boxfi Typ Filter Material'/ Depth Filter Material -_r _�r______________________________ Distant to nea est: Well ____,� ________ ,_ Foundation ---------- Property Line --- ------- ------- \ `SEEPAGE PIT Depth � --_ Diameter ," • i i t I ] p -- �- �-------------- Number .----�J----- - -;----- Rock Filled Yes No i[] Water Ta 1i'-Depth �a ` `: Rock Size -- - --------------- Distance to nearest: Well ------- U`7� S1t Fiivndation _/, _-_�______ Prop. Line S_--____---_.._- L. I __ _________--------.__ �T • - -:�j "''i : td __________________ sw1 1 REPAIR/ADDITION[Prev. Sanitation Permit# _______-.-_________________________ ___-�.-�I_`Date ---------------------------------- Septic _______________ r - SepticTank"(Specify Requirements) -------- ------------------------------------------------------- ---------------- - ------------------------------------------------------r Disposal Field((Specify Requirements) 4 '--------------•----------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I (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 I as to become subject to Wor'kman's Compensation laws of California." ' Signed - ---------------- -- -------------f_I----.--------------------------------------------------- Owner BY yL�hJ-L 1:7--- Title `3 ��------------------- (If oth r t n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- ----- ----------------- --------------------------------------------------------------------- DATE ------ ��JN7_T---------- BUILDING PERMIT ISSUED ----------------------- = -------DATE - -- -------------------------- ---------- ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------------------------------------------=--------------------------- i =------------ ------------------------------------------------------- q ----p - := --------------------------------- -------- --------------- ---------------------------------------------------------------------------------------- ---- ---- -------------------------------- - - - - . -- ------ ------ - - - ------------------------------------------------------ ---- ---------------- - ------- - - FinalInspection by: -------------------------------------------:-------------------------- -- Date - --- - - - --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M