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E FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No,(Complete in in Triplicate) ,,rr F p Date Issued ��Z7:- - This Permit Expires 1 Year From Date Issued Application on is hereby made to fih - --------------- - ---------------------- ---- pp y e 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: �a70U LL'. -- /�2g�-: ;, CENSUS TRACT - JOB ADDRESS/LOCATION -"-"__- --- - - -----Phone - s------- r------------- ----------------- Owner's Name y_ 1 "� Cp City-f � •. (x Y --- -t-=------------------ ------- Address - � Address . ---- --- ----=------------------------------------r---------------------------------------�--�--� a - SD License # Phone Contractor's Name - -"�--- - �Nr--�- -------�------- -----=--_License - ' R Installation will serve: Residence E] Apartment House-F-1Commercial :❑Trader Court [I Motel ❑Other ---G Y ------- = Number of living units------------- Number of bedrooms --_-_- Garbage Grinder --=--------- Lot Size -------------- _ -----------------------Private ------------------------------- ' Water Supply: Public System and name ------------------ ------- -- -- •---------------------- pP Y= I �. . Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [I Clay Loam El Hardpan ❑ Adobe '© Fill Material ------------ If yes, type ---------------------------- e "_--" ---------- -------- buildings, etc. must be placed on reverse side.) f (Plot plan, showing size of lot, location of system in relation to wells, V NEW INSTALLATION: (No septic ta4 or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC�ANK; Size`_-<< - _I"t?------ ---------- Liquid Depth C PACKAGE TREATMENT [ ] lB �II a iZ� {� Type _ Y�pC T aterial-_-C� �'---- No. Compartments ............:.... Capacity I r -- Distance ton rest: Well --�f/-"-�1-�-,e ----------`--Foundation ------------- Prop. Line ---•------ { k ' Total Len th :---�---------•--------- LEACHING LINE [ ] No. of.Lines -- /------------- Length of each-line-----------�Q- ----- g / fit'------------------------------- D' Box --__.j__--- Type Filter Material � _�icc 6 Depth Filter Material ---_-__-- I � ' Property Line. --------- --------- I,--Foundation d----------- P tY Distance to nearest: Well -�_��---- ----� - I,.'—..t- SEEPAGE PIT [ ] Depth "__-.-_--""___- Diameter --- Number ------------- Rock Filled Yes ❑ No �❑ ------------- --------------- 3t --t ...Rock Size -------- ---------------- ----- Water ;Table Depth ------------------------------•----- - i' Distance to nearest: Well ------------------ -:; -Foundation --- ---------------- Prop. Line -----_--------- ----- I M REPAIR/ADDITION(Prev. Sanitation Pe rmit# ------------------ Date ---------------------------- 1 Septic Tank (Specify Requirements) ----_--.,_I-„--------------- - --------------------- ----•---------------------------•-_ - �� 1 .4 kt. fLi1: � >t:-jU3 Disposal Field (Specify Requirements) ------------ ---------------------------------------------------------------------------------------------•------- ------------- - 1 ------------------------ ----------------------------------------------------------------------------------- ------------------------------- --- -------------------------- (Draw existing and required addition on reverse si e) I hereby certify that 1 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 th_e 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�is4issued, ! shall not employ any person in such manner as to become subject{to Workman's Compensation laws of California.".. Signed / - ir---- a= -A gib'"� -------4---f0-1--------------------------- Owner -------------------------------------------- Title' -- -------------- ----- ----- --- ------------------------------------ BY --------- (If of ener) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY0--- �"" -- ------------------- - `----------------------------- DATE BUILDING PERMIT ISSUED ---------------- -' ------------------------------ ----------- ----------- -------DAT ---------------------------------- ----•--- ADDITIONALCOMMENTS ------- - --------------- ----------------------------------------------------------------------------------- - -- -------- ----- - --------------------------------------------------- -------------------------------------- ------- ----- --------- ----- ---------------- -- ---- - ------ - --- -- Date . = Final lnspecti - -- - -- - - - - - ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M ___