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FOR OFFICE USE: + APPLICATION NOR SANITATION PERMIT F -----------------------------------•- Permit No: __��:'� (Complete in Triplicate) ---------------_------------------------- --------------- This Permit Expires 1 Year From Date Issued Date Issued>_ _: -6e 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 .-------- -- ---------------- -------e:!iT------- J--P--Q/V------- NSUS TRACT ----------------------- Owner's Name ------- ----------- ed�3� Q ------------------------------------------------- -Phone Address v �= City r-Pe_S TO (/ Contractor's Name ---T,----A-- -T-��--a-N- ---------------------------------------License # /(6,-586 Phone Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court 0 Motel ❑Other -------------------------------------------- Number of living units ---- Number of bedrooms ...A--.-_-Garbage Grinder __N9--- Lot Size __�_ _d_ ..30�'............. Water Supply: Public System and name ----------------------•--------------------- --•---------------------------------------------------------------Private(� Character of soil to a depth of 3 feet: Sand'M Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe'❑ Fill Material _-l\V-Q--- 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,) 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 Material ...................................--.-----. Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ........................ SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No c] WaterTable Depth ------------------------------------------------Rock Size ------------- ------------------ Distance to nearest: Well ----------------_-----------------------Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -._.____--.--_-.__--__-._.-__-•.__) Septic Tank (Specify Requirements) _______ -__ -__ ____-F_---_ Di Vosal Field (Specify Requirements) _____ --------------------------------------- 3 ---F: - _ ; EAC-N L/ ------------- ----u��_o E.------, d,6_roN ----- �� --=�---------- -N----- EX%STIP r � -------------------- ----- - -- ------- ---- ------------------ -•------------------------------------------------------------------ (Draw existing and required addition on reverse side) I hereby certify that 1 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 t t in the perform nc of the work for which this permit is issued, 1 shall not employ any person in such manner as to bec a subject Wo n's Compensation laws of California." Sig ------ ---------- - - -- ---------- ------�----•------------ - j Owner BY ------------------------------------------------------ ---------------------------7' Title ---------- ------------------------------------------------------------- (If other than owner) j` FOR DE, ARTMENT USE ONLY APPLICATION ACCEPTED BY ---�i--_K_ -0---------- --------------------------- ---------------------------------- DATE ----- BUILDING PERMIT ISSUED ------------------------------------------------------------------ ---------------------- --------------DATE ------ ------ ----------------------------- ADDITIONAL COMMENTS ---- -- ----- - ---- - -------------- -- -- --- ---------- ----- ----------- - ------ -•---- -- -- - ------ --------------- - -- -- - ------ ------ - --- -------- ---- -------- ----- ---- Final ( /lQ ------- --- -------Date _ 1 -- " --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M