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FOR OFFICE USE: Y.. APPLICATION FOR' SANITATION PERMIT (Complete in Triplicate) +' Permit No: v___ This Permit Expires 1 Year From Date Issued 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. 349 and existing Rules and Regulations: • JOB ADDRESS/LOCATI J .--------6161-------- _ -- - -----CENSUS TRACT -----------: "`-------- Owner's Name o •l `'i! E:_ .� -- -- - ----- --------------------------------- -------------------- ------ Address -------- ----------=---- 7� ~� l City -- Contractor's Name -----------=-- ---------- ----%-------------�---- --------.License #A412------- Phone _ [�-- Installation will serve: Residence ❑Apartment Hous_Ieve❑ Comme pial ❑Trailer Court ;❑ Motel ❑ Other __ B 1'�G------ Number of living units______ Numbe�'�of-b6dt'o&6i Z_--Garbage Grinder ""_"---- Lot-Site " _ � ' Water Supply: Public System and name .----------------------------------------------------- Private)< Character of soil to a depth of 3 feet: Sand'[-] Silt❑ Clay El Peat E] Sandy Loam< t C1ay;Loam Hardpan EJAdobe-E] Fill Material-_"____-- If y k,type ....... - -------------- (Plot plan, shrowing size. of lot, location of system in relation to wells, buildings tc mustsbe placed on reverse side.) f " # NEW INSTALLATION: )' } � � (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENTj[ ] SEPTIC TANK ize __y7x9- ---_----__ __/__ Liquid Depth Capacity/ TypeMaterial__Li -- ------�_,!!I/No. Compartments ---- ---- . r t Distance to nearest: Well -----516- ---------- ___ _Foundation��__/a_f'-____ Prop. Line //__.__----_.__________ \ LEACHING LINE ' No. of Lines ____ _ ______________ Length o4ajch. me-______ ____ __ _-___ Total Len Length �L�_Q__....._______ �' . I f' � I /' � '1h _ 'D' Box .._ _ Type Filter Material ep ` -'- � - � th�Fi•lter�`Materia! --- �----------•----------•-•--•------- r ---__.___ Foundation r i Distance to nearest: Well _�_�- ;---��--�"------ property, Line. ------------•-•--..:..__ , SEEPAGE PIT [ ] Depth De p ____._.__ --------- Diameter ---------------- Number ------------------------ Rock Filled Yes ❑ No I❑ Water Table Depth ______*..--�- ------------- --------------J.Slv`�Rock Size ------------------------- -- 1 ._ Distance to nearest: Well ______ ________________ _Foundation _.___--_-------_____ Prop. Line _._.__..__.._ _.. -. S. i �'" Date ` -------- Septic ) REPAIR/ADDITION(Prev. Sanitation Permit#{ ____._._.__-______________________ 5e tic Tank (Specify Requirements) . `_____________• - P l P Y q l Disposal Field (Specify Requirements) ------ ----------- ----------------------------t----``. ----- 4 ----------- '-- --------- --------------------------------------- -------------------------------------R-.--�------------------------ --------------------------- ------------�-----_ n d .;'�--�-.� - - - -- - -------- -- ----------------------------------------- ` ,r . --- -=---------------- {Draw existing and required addition on•reverse side) '4 - r 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 4 Owner BY ------=---- -- -------------- -------------------------- Title (f othe n1ownerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8 rte- DATE �2 ~Z BUILDINGPERMIT ISSUED - - ----------------------------------------------------------------- -------------------•---------- ---DATE ------------------------------------------ ADDITIONALCOMMENTS ------------ ------------------------------------------------------------------------------------------------- -------------------"------------------------------------------------------------------ --------------------------------------------------------•-•----------------•--------- ---------- ---- --------------------------------------------- ------ -------------------------- ---------------- --------------r Final Inspection bY: 5- - ----- - ------Date -------�-- 2 ----G7 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 T-'68 Rev. 5M ,�