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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / +` ---------------- --------------------------------------- Permit No. {Complete in Triplicate} ---------- ---4-90 --- ------------ _�i_--__________...... This Permit Expires•1-Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 .- .- - --.�`-/_- --__- -- :- --- d---y-- -----------------------CENSUS TRACT ----------------_-------- .4 --------- - ---_- - - - Owner's Name ----------Phonegwo 37/C...... Address --------- -i ` -------------------------------------------------------- - = ------------------------------------------------ Contractor's Name ------ - ---- ------ ---- / License # -. -----__---- Phone - --�J- r�� I- Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑ Other'_ 't' ---------- --------------------- / Number of living units:---- ----- Number of bidooms _-_�-Garbage Grinder ________ ... Lot Size -f!-y .-_-------- Water Supply: Public System and name ---------------- :------'-_..------------- ---_--------- - ---------------Private - - ------------ - ---------------------- Character of soil to a depth of 3 feef: Sand Silt ``Cla Peat El Sandy Loam Clay Loam' Hardpan ❑ Adobe FilhMaterial'_ __._.___ If yes,type'---. (Plot plan, showing size of lot, location of system in relation to well's; buildings„ tc, must be-placed-on-reverse side.) NEW INSTALLATION: (No septic tank or seepagept permitted`if 'p -is aJailabie within'200-f et;)x— PACKAGE TREATMENT [ I SEPTIC TANK'[ ]. ., _ Size------------------------------------------ ---- Liquid"DePthf -------------- Capacity -------------------- Type -------------------- Material---------------------- No. !Compartments ----------------- °n Distance to nearest: Well ------------------------------------Foundation '------------ ------ Prop. Line ---------------------- LEACHING --------- ----- -LEACHING LINE [ ] No. of Lines ____________________ Length of each line:__-_ __ _______ _____ _______ _ Totdlt-L-ength ----------------._....... .-_ 'D' Box .----_------ Type Filter Material -------------------- epfh'Filt r. Material -------- ------------------------ ...... N Distance to nearest: Welldation ______ _____ Property Line --__--__._-_______....:. SEEPAGE PIT [ ] Depth -------:------------ Diameter ------:---- Number -----------------=----------- Rock Filled Yes ❑ No i❑ 1 Water Table Depth., ------------------------------------Rock Size ----------------- ------------- Distance ---- ----Distance to nearest:.Well --------------------------------------------Foundation i------------------- Prop. Line Y _ ---------------------- --------------- REPAIR/ADDITION ________-______--___. __ ______ _REPAIRJADDITION(Prev. Sanitation Permit# -;zbate ------ __________:_____. Septic Tank ]Specify Requirements) ________________ ' moi ' -----------------------------------------------.- --------------------------- "y i F Disposal Field (Specify Re irements) ----- = ---------- -------- #_ t , � Draw existingand required addition on reverse s -------------------- 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 hcen- ' sed agents signature certifies the following: ' "1 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 i BY - - ----� ---- = Title (Alf ----- jowner owner] FOR DEPARTMENT ONL APPLICATION ACCEPTED BY -------------- --- - = ------. DATE ---27 776 --------------------- BUILDING PERMIT ISSUED r-----=---------------- - - -- --«' --- -e ---------------- DATE ------------------------------ - - ----------- ---- - ---=-------- ADDITIONAL COMMENTS _-Z ' ” �'�` --------------------- -----------=--------------------------- --------------------------------------------------------------------- - - _'-- - - ------------------------------------------ Final Inspection bY- ------------------------------------------------------`-;---- -- Date = - --------------- --- SAN J9AQUIN I.Q. ,L;;H ISTRICT E. H. 9 1-'68 Rev. 5M