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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ------------------ --- --------------------------- Permit Na. - g-. -S (Complete in Triplicate) II� l.y 7/ ----------------- ..- -- �l__ This Permit Expires 1 Year From Date Issued Date Issued .- ' Application is hereby made to.the San Joaquin Local Health District for a PP Y q 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/LOCATIO ;= A-------_n-- .......4 C- , ;4--"-. --------------------------CENSUS TRACT -------------------------- Owner's 9 1 --- � 3 ' Owner's Nam .-- `--- ------------------------------------------------------ -----------------.-Phone ------ - - -- - --------------- - Address --.-.-- ,5/, - : ---- - ----------- City --- as—_,f, -- Contrpctor's Name -.--- I� � � �, �'c.� - license # 2-� - -------" -- Phone ------------------------------ Installation will serve: Residence eApartment House❑ Commercial :❑Trailer Court Cl Motel ❑ Other -------------------------------------------- .f Number_of-living..units:-.--- ----- Number.of bedrooms --,S__---Garbage Grinder- --------- Lot Size,----,,____------_____--__--_------------- - Water Supply: Public System and name ---------------------- --------------------------------------------------------------------------------- ----Private Character of soil to a depth Iof 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ,E] Hardpan t?r Adobe ❑ Fill Material ----------- If yes, type ------.---#----------------- j (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,) PACKAGE TREATMENT p SEPTIC TANK [Ir" -Siz-e--�S. ---. -_-- -- -`------------ Liquid Depth -------------------- Capacity r -.- CaacitY 1aP-dType - - ---- Material---- - (I} ' I No. Compartments --`�-------•------- � Distance to nea est: Well ----------So --------------------------Foundation --- 0_r--------- Prop. Line .--`-------------------------- LEACHING LINT= {� NoiofiLines "_ ----------- Length of each line------�4.O.`-_________. Total Length 6............... D' -Box .- ------- Type Fi'lter:Material ---- -lZ-----Depth Filter Material ------1_11-_----------------------------- 1` t- " . I ! i V r Distance to nearest: Well ---.----6-a-----_.___ Foundation ___.l-�_- ._------- Property Line ------------------------ SEEPAGE PIT Depth ----- - _�__- Diameter _--- Number ----------49--------------- Rock Filled Ye5`gT No i[] Water Table Depth ----------------8_rj--------------------------Rock Size3 ; 1 Distance to nearest: Well -----------4-9 p--------------------Foundation ---A-0+.-_---___. Prop. Line -__--5..-.----- _ . REPAIR/ADDITION(Prev. Sanitation Permit# --------.----------------------------------- Date ---------------------------.___-__J t SepticTank {Specify Requirements) --- ---- -----------------------------------------------------------------------------.------------------------------------------------ i DisposalField (Specify Requirements) ------------------------------- -----------------------------------------------------------------------------.------------------------ --------------------------- ------------------ ----.----..----_---------------------_---------__----_-.--------------_-_.--__------------------_--------------------------------- --------------------- : (Draw existing and I hereby certify that I haveprepared this application and ulthatat eitiwork will reverse side) be done' in accordance with rSan Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies'I 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 .. I� ---------- - -- ------------ Owner - - BY ----------------- -----------------------II -------- ------ ��- 2�r Title -------------- (If other than owner) I I� FOR DEPARTMENT USE ONLY + aF ------------------------- APPLICATION ACCEPTED BY: DATEf BUILDING PERMIT ISSUED --1---------------------------- --- ----------------DATE ------------------------------------------- ADDITIONAL COMMENTS ---!l------------------------------------- ----------- - ----------------------------- ----- ------------------------------------------------ -------------------------------------------- ------------------------------------------------------------------- --- ------------------------------------------------------------ ----- -------------------------- ----- ------------------------------------------ --- 'll -- -----------------------------------------------L---------- ------- ---- ---- - - -- Final Inspection by: . ------------------------------------ ---- = Date _ "l- �� f SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.