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' FOR°OFFICE USE: APPLICATION FOR SANITATION PERMIT --------- - ----------------- ------------------------------ Pe {Complete in Triplicate) rmit No. -----D` .CP-�� ----------------- This Permit Expires 1 Year From Date Issued Date Issued _9_/7_;?P 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 I JOB ADDRESS/LOCATIONS33_�--�__+��P�ISLtJ(C/r---- q�� CENSUS TRACT Owner's Name S IY_ 4s zk/��----amE --------- -------Phone Address `3��•1 e. Tsll,2 -ew...... --------------------------- ----- city ----- 5-X7—/e_-� --------------------------------- ------- Contractor's Name�et f:. �- ----- fcr /�- G---:------License # --- Phone W- 4(- ----------- Installation will serve: Residence E-Apartment House❑ Commercial []Trailer Court i❑ Motel ❑ Other Number of living units:_._. _._ Number of bedrooms ___az__Garbage Grinder ------------ Lot Size ------------------- Water _Water Supply: Public System and name _______________ __Private' t Character of soil to a depth of 3.feet: 5and'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam R-"`CIay Loam ❑ s Hardpan ❑ Adobe '❑ Fill Material -------- --- If-yes;type`---_--- _-,-=----- -_ (Plot plan, showing size of lot, location of system in relation 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,) 1 r PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------- ------- Liquid Depth --------------------- --•- Capacity ---------------=---- Type ------------ ------ Material----------------- --- No. Compartments ------•---------- Distance to nearest: Well,.-----------------------•------------Foundation ---------------------- Prop. Line -------_--_----------- LEACHING LINE [ ] No. of Lines ---------- - " - --- ___-- Len gthF of each line--- ------------------------ Total Length ,----------_---•------_--•-- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------•----------._---___,_-•- Distance to nearest: Well ________________________ Foundation Property Line -----.__._.___--__---___ -SEEPAGE PIT [ ] ; Depth ---- --------------- Diam 4 eter ________________ Number ---------_ _ -__-.______-__ Rock Filled Yes ❑ No i Water Table Depth ------------------- ----------------------------Rock Size ---------- ----------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _..-__---_---------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------_-------••-•--------_-_-) Septic Tank (Specify Requirements) '-----------------_______ - - ------------------------ ------------------ .-------------•------------- ------------- j° Disposal Field (Specify Requirements) . ___ gd DJ_-----/�� - �e� -!_ - � //? 7 rt� s T ,-------------------------------------- 6 1 _ (Draw existing and required addition on reverse side) I _T hereby certify that I have prepared this application and that the work will be done in accordance wifli 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: a "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner r as tobecome su 'act to rk 's Compens on laws�of California." Signed --- . ------ --- ---------- ------------ Owner BY ----------------- -------------- w ------------- Title n _.. : (If other than, oner[ F R .DEPAR T USE ONLY APPLICATION ACCEPTED BY -- --------------i - -----------__-- -- DATE -- -- --� - 0�-- ---------------------------------- ------------------ BUILDING PERMIT ISSUED ---- -------------------- -------- ------- --- -------DATE ------------------------------------------- --------------ADDITIONAL COMMENTS •------------------------------ ------- --------------------------------------- -------- ---------------------------------------------------------------------------------------------------------- ------------------------------------------------•- ------- --- ------------- -------------------------------------- ---------------------------------------------------- - ---------------------- --------------------- ------ - -- ------- ----- -- ----Final Inspection by: h - -------'-t U----------------------- Date --- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M - *�`