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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ------ ------- ----------------- - 0DateThis Permit Expires 1 Year From Date Issued 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 .---5 //_ ---S-S'__ �__ �-------------------------------------------CENSUS TRACT -------------------------- Owner's Name ---s��rr:_e c-_e-w ------�!roti CSF----------------------------------------------------------- -------Phone Address -------- City ;`Zl �oy --------------------------------•----•-- Contractor's Name -------- ----------------------------------------------------------License # ----------------------- Phone -------------------•- Installation will serve: Residence 9?<partment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other Number of living units:___`______ Number of bedrooms __ _______Garbage Grinder +�____ Lot Size --- Water Supply: Public System and name ---C1yl-�--------------__-- __ ----------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ElHardpan ❑ 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.) NEW INSTALLATION: (No septic tank or seepspa pit permitted ifublic sewer isov4able within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK:e OX'�SlV � e --- -- -------------- -- [ Liquid Depth Capacity ------------- Type ____________________ Material_______-____ ____--_ No. Compartments - -------- Distance to to nearest: Well ------------------------------------Foundation ____-__-____-____-___ Prop. Line __-__________ ..__ - LEACHING LINE [6j-�No. of Lines _ 00, ........... .k ---�---_-________ Length of each line___�Q--�_____________ Total Length ____�f-Q� 'D' Box WO Type Filter Material----------Depth. Filter Material -----/__40r`�e____________________ Distance to nearest: Well ______________________ Foundation ------------------- ----- Property Line SEEPAGE PITDepth - ---- - - ---- _ Diameter - ----------- Number _----------------_______--- Rock Filled Yes E] No 0 [ ) Water Table Depth --------------------------------------- --------Rock Size Distance to nearest: Well ________________________________________Foundation --------- ---------- Prop. Line _______-_-_________-_ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _________ Septic Tank (Specify Requirements) _--__-_ �, ___ ---- ------ isposal Field (Specify Requirements) _ _ __ _ ------------------------------------------------------------------------------------------------- -------------- ----------------------------------------- - -- -------- - - - - - - ----- - - ----------------------------------------------------------------- (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 becom ubpect to orkm 's Compensation laws of California." Signed ----------------------------------------- Owner By ----------------- -- -- --- ------- ------------ - - - ------------------------------------------------------ Title ----- ----- ----------------------------------------------- (If of er t n owner) ------ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _____ .*f BUILDING PERMIT ISSUED -- - -- --------- ------ --- - --------------- - - -------- -------- ---------------- DATE _A _1;'.r`__ rj' 4 A DITIONAL COMMENTS --------T54Z;_ --- TE --------------------- ----- --- �p Et79��S -- --- - �- t(Jtjb f* Hra �J Ft�` -------------------------------------------- •--------------------- --- Final Inspection ------ - - -e--------f�-e:- - ------------ -'- -or------- ----------Date --- SAN -SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M