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{ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------.------------------- 1 ---- --Z��-- ----� (Complete in Triplicate) Permit No. ----------------------------------------------------`- ' �I - This Permit Expires 1 Year From Date Issued Date issued 1! 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 existing Rules and Regulations: JOB ADDRESS/LOCATION: l__12 IYCo-___---__ r_ _._ CENSUS TRACT -------------- p__-7_ _ Owner's Name '.AelI�L -- ----- ---------- Phone '-/l-C-/ �`Address �I 1- -•-------- �'---- ----•--• City _�/LBi! " a�- Contractor's Name _-Q• .---'-••--- / `-e'-------------------------------------- License #pF/__ Phoned';� _" !�4_ Installation will serve: Residence Q Apartment House,❑ Commercial :❑Trailer Court ;❑ Motel ❑Other7�j / g g ,r/Ic Number of living units_____________ Number of bedrooms __ Garba a Grinder _.__________ Lot Size __ I� - 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 ❑ Adobe ❑ Fill Material __________ If yes, type ---------------------------- (Plot ---- ----------------- --(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,) 11' -- PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size----- ___--__-- Liquid Depth --- ;a--_-_-.•___,_____ t Capacity O��7' ' ------ Type _ Material__1: +-! o; Compartments _Z__/ Distance to nearest: $- ----Well __ r �-- - ---------------- ---- --Foundation --- -------------- Prop. Line ---0---:------------ �4 LEACHING LINE [ ] Nlo�. of Lines __,3----------------- Length eac line____.CF__Q.________.._____ Total Length �_�� ql, A, - -- --------------- 'D�' Box ------------ Type Filter Material ___,Depth Filter Material -------------------------------------------- Di '0,9A, ___ __________________�______------- Distance to nearest: Well Foundation _____._ ------- Property Line _ . SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth ------------------------------------------------Rock Size -------------------------------- i Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------ .............. + REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date _-__--_-__________________________) SepticTank (Specify Re".1uirements) -----------------------------------------------------------------------------------------------------------"--_----------------------------- Disposal Field (Specify :Requirements) ------------ ------------------------------------------------------------------------------------------------------------------------ -------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- ---------------------------- -- ----- -------- -- -q---------- a---- --o------ -- __ ---- ------ - -- ------------------------------------------------------------ - - (Dra--- --w existing and reuired add 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, StatetLaws, 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, 1 shall not employ any person in such manner as to become subject to i Work an's Compensation laws of California." Signed ----- --- ---- - -------------------- --------------------------------- Owner By ------ --- '' -- ------------- -Title ------------------- -- ----- ----- ---- ------- -------------- --------------- - ---------------------------------------------------------- ------------- (If other than owner) III FOR DEPARTMENT USE ONLY t M APPLICATION ACCEPTED gi3Y _..- --- --l- --'��_�_�_ ----------------------------------------------------------------. DATE - -/7..?7--r1--2----------------� i BUILDING PERMIT ISSUED' ---- DATE ------------------------------- ---------- ADDITIONALCOMMENTS'1-- ---- -------------------------------------- -------- - - ---------------------------------------------------------------------------------•---------------- i ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- it ------------------------------- ------------- - ------ Final Ins ection b !lc� .-------------------------------------------------------------------------------Date __/-/c� =��--------•------- I p Y --- --- EW. 9 ]-'66 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT " 4 .