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FOR OFFICE USE: APPLICATION YOR SANITATION PERMIT Permit No. (Complete in Triplicate) _�_ __-_ _________ } Date Issued _6Id-17 .. -------------------------------------------- -------- This Permit Expires 1 Year From 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 _ _�Y- f __ ___ __--___ ___________CENSUS TRACT --------------------- Owner's ____ ________ ____Owner's Name ' .__ yam ------Phone- ------ ==--------------------- / - --- Address / fir .f City ` " Contractor's Name ----- --- ' `a= / ' _ License # _ 1�`< _ � _. Phone --- ------------------------ Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court I❑ Motel ❑ Other ------------------------------------------- Number of living units:------ ___ Number of bedrooms _Garbage Grinder _________ Lot Size ____4,2ef ...... Water Supply: Public System and name __________________________________Private [fes Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam E!Y"'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.) 1114 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 0 Water Table Depth - ------------------------------- Size ---------- --------------------- Distance to nearest: Well _____________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _________._____________________-) Septic Tank (Specify Requirements) _____ ___ _ _ ____ ----------- ____ _ _____Disposal Field (Specify Requirements) 4 _ � � V. y_, r+-Z�_ ------- ,Y -__ /� = �. _ -- ------�'�------..-- tom _�� ------------------------ -----------1,3_L „ ,S'' --------------------------------------------------------------------------------------- (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 ------------------ -------------- ---- t-------- - Owner BY ----------------------- Title l'? t' (►l"-- ------C-----c--L--------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � -1- - - -- - DATE '__"_ . ':'-' - BUILDING PERMIT ISSUED ----------------- -----------------------------------------------DATE --------• ----------------------- ADDITIONAL COMMENTS - ----- --------------------------------------------------- -------------------------------•-------------------------------------------------------- ------------------------------ -- --------- ------------------------------------------- ----------- ------------------------------------------------------------------------------------------------------------------------------ - -------- ------ -- ------------------- '` --"------------------------------------------------------------------------------------ --- Final Inspection bY: `------ -- ----------------------- - ---W/------ --------------- ------------- - - - - - ------- -- - - ---- - - -- -------------- Dater-�-7` - -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M