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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- ---- F Permit No. I (Complete in Triplicate) - ------------------ �1 ------------------- Date Issued ____ i `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 . O '.t1------I/------- --------------- - ------- -----CENSUS TRACT Owner's Name -_ /9t4 ---•------•---•----------- ---------------- -------Phone.. 31 7 Address ---- -------------=---------- ----= ---------. City ---S-TOC_ ------------------------------ Contractor's Name - - ' ---------:5 ------------------------------------------------License # --- Phone Installation will server Residence impartment House❑ Commercial:❑Trailer Court i❑ Motel ❑Other ----- ------- ------------------------------ � Number of living units:----7----- Number of bedrooms ________Garbage Grinder -----------sF Lot Size - ______________________________ Water Supply: Public System and name ---------------------- ------------ '4------- ------------------------------- ----------------------------Private 2`.. Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay ❑ Peat❑ Sandy�Loam ❑ Clay Loam_❑ Hardpan ❑ Adobe.g Fill Material __._ -_ If yes, type ---------------------------- t f Y (Plot plan, showing size of lot, location of system in relationt.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,) \ r AO le PACKAGE TREATMENT [ SEPTIC TANK [ ] Size__ lt'sG-a'.`1 _____________________ Liquid Depth . S_ ._._..._,..... Capacity ffeo_644TypeJ '. � `Material L°C? G� �No. Compartments ry Distance to nearest: Well ____7_ `_ __---___Foundation r--------.Prop. Line ___x_____________ LEACHING LINE [G}- No. of Lines ------ ____________ Length of-each line-------- r_r--------- Total Length ____Z,7`U____........ 'D' Box _� _ Type Filter Material ___ d_Gfr__Depth Filter Material ------tei!r------ Distance to nearest: Well ----me-fes Foundation ____ ar_.____.__ Property Line, -- ............. �r ------_ Rock Filled Yes No 0 [ J SEEPAGE PIT [zj' Depth .--�--,.�____-- Diameter ---�..��___t-- Number --------�- Water Table Depth ------ ------------ ------ .Rock Size ----2-- ------------------- _ Distance to nearest: Well ____________________Foundation ------1.-q........ Prop. Line ... -.- ............ REPAIR/ADDITION(Prev. Sanitation Permit# _______________________________________ Date --------------------.-____________) SepticTank (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 s blect too Wort r Compensation laws of California." Signed BY ----------------------------------- ------------ ------------------------- Title ---------- -- ----- - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ --�-- --------------------------------------------------------- DATE S�V/z .6�1 ------------------ BUILDING PERMIT ISSUED ------------ ------------------ ----------------------- ------------------------------------------------DATE ------------------------------------------ ---- ADDITIONALCOMMENTS ------------ --------------------------------------------------------------------------------------------------------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------- - --------------------------------------------------- ---------------------------------- ----------------------- ° -------------------------------------------------------------------- -- - ------- -- ----------------------------------------------------- Final Inspection by: ---------------------------------4) -�---" stn-------------------------- ------------------------ Date --- -- - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M.