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FOR OFFICE USE: ------ APPLICATION FOR SANITATION PERMIT ------------- --------------------- - - - (Complete in Triplicate) Permit No: -a___"_Id '6 ------------------------------------------------------- --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued x_.7 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 -----------1_81W Cx ---- ----4 1�SL C-94:---------------------------------------CENSUS TRACT .. ------ -------------- Owner's Name ------- ---------------�1_IUQ----EACr-kei-n------------------------------------------------------------------ --Phone ------------------------------------ Address ------------------------------------- --- 4't ---- - City __T ---------------------------------------------------------- Contractor's Name ------------ -------------------------- ------------------ -----------------.License # ------------------------ Phone ------------------------------ Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑f ther ------hsblSbeYy_x_-�-______________ Number of living units:-------t------ Number of bedrooms -----A---Garbage Grinder ----'-'---- Lot Size _____AG_fe&c__.---___-_--___-____ Water Supply: Public System and name -----------------------------t----------------------------------------------------------------------------------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,) PACKAGE TREATMENT SEPTIC TANK j?„C�_________ �' [ l [� Size-------------- --------- ----- Liquid Depth ---'All, '*,.4 Capacity ADD-0-------- Type _�c> . ,----- Material___ No. Compartments ............. O Distance to nearest: Well --------a_)r-_______________Foundation _____10------------ Prop. Line ._-c . d LEACHING LINE No. of Lines Length of each line_______ [ ) -------- g �------------- ------ Total Length ---[80.................. 'D' Box ``ie_S___ Type Filter Material (_ ------Depth Filter Material -------Ist;-------------------------------- �.��, Distance to nearest: Well -----10D-x _ __-____--__ Foundation _____ _�_- _ _-.__ ___ Property Line ____w�c(X.. ......... SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ------------ --------------- Rock Filled Yes ❑ No Water Table Depth ---- -------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation _____.-_____-_-__- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) Septic Tank (Specify Requirements) ------------------------------------------------------------------. Disposal 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 become subject to Workman's Compensation laws of California." Signed - - --------- ------------ Owner (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------ - - DATE -;5 BUILDING PERMIT ISSUED -------------------------- ---- --- ---------- ------------- - --------DATE ------------- ------------------- --------- ADDITIONALCOMMENTS ----------------------- ------------------'---------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------------------------------------------------------ ---------------------------------- c- Final Inspection by: - ------------------- ---- -- -- - ------Date -- --------------------- SAN JOAQUIN LOCAL HALT STRICT E. H. 9 1-'68 Rev. 5M