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'FOR OFFICE USE: 7zov,- APPLICATION FOR SANITATION PERMIT - - "---------------- --------------------- "' Permit No: _.7.1✓__�. ` (Complete in Triplicate) ------- ----------- Li _______________--_-_ This-Permit Expires 1 Year From Date Issued Date Issued -�.'_� _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: �,r JOB ADDRESS/LOCATION . 100. ------2-1,q ----- qVA( ----------------- -----------•------------- -CENSUS TRACT -------------------------- Owner's Name 1k -e-I �- r-------------------------------------------•---- -- -- -----P one " _ , el— Address --- ----- ----------- ---•-----•--.City, � -lp ----------•------ f Contractor's Name..--/9..... -- / �-5 ,--- --- __g---•- ------.License # /f _ ll---- Phone Installation will serve•. Residence Apar ent House,❑ Commercial :❑Trailer Court ;❑. Motelther ---------------------------------•----i----- Number of living units------ Number bedrooms -,3-----Garbage Grinder ------------ Lot Size / X/ --._ Water Supply: Public System an 4a-me _--..__________________.__ Private j--------:tea- ---:- _ — - xc ❑ Character of soil to a depth of 3 eet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ AdoI>e Fill Material --I_'--------- If yes, type ----------- -------------_-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be PI1ced on reverse side.) NEW INSTALLATION: (No septic tank or seepage pitpermitted if public a er is available within 2p0 feet,) PACKAGE TREATMENT [ SEPTIC TANK'[ ) Size-------------------- ---------------------------Liquid Depth --•----------------------- Capacity �`` ' Material---------------------- No. Compartments ----,_..--_. ----------- --- Type ,.------------------ - - Distance to nearest: Well ------------------------I------------ undation ---------------------- Prop. Line ---------------------- LEACHING LINE { ] No. of Lines ________________________ Length of each line__ __ ----------- ---------- Total Length -----------.-__________..:_- 'D' Box ------------ Type Filter Material --------------------- YpDepth Filter Material -------------------------------------------- q Distance to nearest: Well ----�---------_--- Foundation ------------------------ Property Line. ----------.-----._--.--- SEEPAGE PIT Depth ___________________ Diameter ---------------- Number _-._.-_.______.__"_ ------- Rock Filled Yes ❑ No C]Water Table Depth ----- --------------------------------------- Rock Size - ---------- ----------- - Distance to nearest: Well ----------------------------------------Foundation --- ----------____-- Prop. Line ------•----•----.-_--- REPAIR/ADDITION(Prev. Sanitation Permit# __ i¢_ 9_ 7--- Date Oma._____) Se tic Tank (Specify Requirements) ------------------------ DisposalField (Specify Requirements / / h------- --------------------41r 9w—J-4AF - ---------------- I�--------------------------- 1 (Draw existing and required addition on reverse side) , I hereby certify that I have prepared this applicat~ tion anal tat w6r"V-`wiII'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: "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." Signe Owner - --- --------------------------------------- --------------- -------------------------------------- Title --- ��- ----------- If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -------- ----- -- (�-- -- --- ------ -------- DATE -71 BUILDING PERMIT ISSUED_ _= _ --• __= _ = = - _ -—_ __=DATE ADDITIONAL COMMENTS ---------------------------------------------------- ----------- - ------ - ----------------------------- - ----------------------------------------------------- - --- -------------------------- -------------------- -------------------- ------------------------- ----- --- ---- --- --- --- - Final inspection by: - - ---- -- --------------------- • ----------------Date ---- --- - 1 SA Q IN LOCAL HEALTH DISTRICTS i 1� l� E. H. 9 1-'b$ Rev. 5M . }