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,FO --OFFICE USE: APPLICATION FOR SANITATION PERMIT - -------------------- ------------ -- - -------- Permit No: _1_"_�._ j 0------ - -----'-- � (Complete in Triplicate} Date Issued _/.�__-:-�_�_. t w This Permit Expires 1 Year From 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. .� -- `� CENSUS TRACT ----------------------- JOB ADDRESS/LOCATION -----, _°1*Yn-----!_)- -- -- --- ��,- s � �' -- -------5- --- r Owner's Name - -------------------------------------------------------- Phone Address f?- -----LO-0 ------------------------------- City ---0-L2U-4-a- - .Ez------ —9-q-41�a_ Contractor's Name ------- -------License # __2kJ7!?4/_____ Phone Installation will serve: Residence W'Apartment House❑ Commercial ❑Trailer Court Motel ❑ Other ------------------------------------------- Number of living units:-----I------ Number of bedrooms ___ ,____Garbage Grinder ___________ Lot Size ._ 11___ '1"- -- ______ Water Supply: Public System and name ------------- -------------------------------------------------------------------- ------Private [ J r Character of soil to a depth of 3 feet: Sand)� Silt❑ *, Clay ❑ Peat❑ Sandy loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑• t=ill Material ___________ If yes, type ___________________________ ,y (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) f" NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �J PACKAGE TREATMENT f I SEPTIC TANK:[ I Size------------------------------------------------- Liquid Depth -----------.---------.----- �. Capacity Type ' Material -- No. Compartments ...................... Distance to nearest: Well ------------------------------4_-J_._Foundation ----------------- Prop. Line ________ ............. LEACHING LINE [ No. of Lines _________ _------------- Length of each line-------�_l._. �.___-�-_- Total Length { 'D' Box ----/------ Type Filter-Material _______-___ .`..Depth Filter' Mdteriai _________ ___ __ ------__ ______________ '10 J0 j Distance to-nearest:-Well _" "C�_______ Foundation ______�- -;_____ Property Line. _ ...... SEEPAGE PIT [ ] Depth ±___________________ Diameter '__:_____________ Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------•_..Rock Size -------------------------------- Distance to nearest: Well --------I-------------------------------- Foundation -------------------- Prop. Line ___________--_--_ -__ PAADDITION(Prev. Sanitation Permit# -------------------: 4 ----------- Date ----- ` ----------------------- Septic ) Septic Tank (Specify Requirements) ---------------- -- -- --------------------I-------- ----------------- Disposal Field {Specify Requirements) ---------_C-- P______-- �-----�J�----------------------.------;-------- ' ---------------------------------------------------- _ ___________-___-._________ _ _ __ ______.--_._______________-__--____________________----------_-_.--_-______________________._.__________ (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 h BYE• . ' = Title --------- �- J (If other than owner) FOR DEPARTMENT USE OISIILY t APPLICATION ACCEPTED BY ------------ ----------------------------' ---- = ----- ----------. DATE 16:r '= � ------------------- BUILDING PERMIT ISSUED ------------------------- -- --DATE ------- ----- - ADDITIONAL COMMENTS --------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- -------------- -------------------------------------------------------------- -- ------ b ---------------------------------------- --- : . a � -Fi ----- Date ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M r