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FOR OFFICE USE: APPLICATION FOR SANITATION' PERMIT w�9� - .._ _ . . : - . .. Permit No:. (Complete in Triplicate) ----------- This Permit Expires 1 Year From bate Issued Date Issueclx-_, =�_01 r 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 Count r inance NO. 549 and existing Rules and Regulations: ,40TJ JOB ADDRESS/LOCATION 9. ' _-- -------- 7 ._ ---___--CENSUS TRACT - ---w Owner's Name --- j ------04-14� ---------------------------- --------------------------------- ------Phone ••------ •- Address �F - �__Z6 171 C 7- -------------------------. City 1 G� Contractorq Name . ',�` C= - ----------- ---•-- License # /7,?_M3--- Phone ------------------- y r Installation will serve: Residence,K Apartment House❑ Commercial❑Traiier Court ;❑ ti Motel ❑ Other i Number of living units:__-_--- Number of bedrooms __a2------Garbage GrinderA/CJ_._ Lot Size ._5 , Water Supply: Public System and name ---------------------- --------- ------------------------- - --------------------- -------------------Private ❑ Character of soil to a depth of 3 feet: Santk Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ i Hardpan ❑ Adobe-E] Fill Material ------------ If yes, type .___,__--___-------------- (Pl'ot plan, showing size of lot, location of system in relation to wells, 4w y 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,) i PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth -----------------------_-- ; Capacity ----------- -------- Type -------------------- Material--- ----------------- No. Compartments ------ ----- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------- ------- LEACHING LINE [ ) No. of Lines ------------------------ Length of each line---------------------------- Total Length �(! 'D' Box ------------ Type Filter Material __--_-_-____-------Depth Filter Materia! ---------------------------- ------------- Distance to nearest: Well _______________________ Foundation ------------------------ Property Line. --________-__-__-._.-___ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ------- -------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well _____._--_____________________________Foundation -------------------- Prop. Line _____-_-___.______. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 Septic Tank (Specify Requirements) -------- ---------- -----------------------------------------------------------------------------------,,. Disposal Field (Specify Requirements) ---671-052.. ..... - ---.e2, _ - .aldw--------------- ---------------------------------- ------------- -------------------------------- -----------------------------I---------------- ---- t - -------------------------------------------=--------------------------------------------------------------------------------------------- (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 subject to Workman's Compensation laws of California." Signed ----- ------ - - -- Owner - - ------------------------------- - - --------------------- BY - ----------- - ----- ------ Title ---------------------------------------------- ------------- lWotWr of r f an owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --__--- --` -- -_ ---------------.DATE ._. _- '-�C --------------- BUILDING PERMIT ISSUED - ------------------------------------------- - ------------------DATE --------------------------------- - t ADDITIONAL COMMENTS ----------------------------------------- ------------------------------=---------------------------------------------------------------------------------------------------------------- ------------------------------------------ ; --------------------------------------- s Fina! Inspection b �--- -- „;-'�-�-------- ------ ------------- =- --- ------------ -- - -- -pate -��-=�U-- -`��-------------------- SAN - ------------ ---- p Y ------------------------------------- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.