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FOR OFFICE USE: l-bjkpPLICATION FOR SANITATION PERMIT ell-/6.--6 v------ ( \'2 l Permit No. (Complete�in Triplicate) -------------------------------- ------------------I This Permit Expires 1 Year From Date Issued Date Issued 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 Rud a d Regulations: JOB ADDRESS/LOCATION _G �L` { _ �ASUS TRACT Owner's Name - _ ----------Phone ------------------------- Address --------=------------------------------------------------- City ------------------------------:----.- Contractor's Name - ISS---------------------------------------------------------License # -------- --------------- Phone ------------------------------ Installation will serve: Residence ❑Apartment,,Ho//use❑ Commercial []Trailer Court ;❑ Motel Cether LGtt--------------------- Number of living units:_-.______- Number of bedrooms ------------Garbage Grinder ------------ Lot Size __-____-_--_:____._--------------------- Water Supply: Public System and name --------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam❑ 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,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------------------------------ -------.--------- Liquid Depth ____-_-__---._.-..._____- CapacitY ------------------- Type -------------------- Material-=---- ---- No. Compartments ------ ............... Distance to nearest: Well ______-_--------------------------Foundation ---------------------- Prop. Line ___._......... ........ LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ___.-______----._-..._. 'D' Box ------------ Type Filter Material ____________________Depth Filter Material --------------------I....................... Distance to nearest: Well ________________________ Foundation --------------- -------- Property Line -----------------_---_ SEEPAGE PIT [ ) Depth ----------- -------- Diameter ________________ Number _.-------------------------- Rock Filled Yes '0 No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ________________________________-_e__--_.----- Date _-_-_-__._-__-_-.-_---__-....._-__) Septic Tank (Specify Requirements) --- - i?s�l__l�_pn -__t fti�__._ � .l"t.C?_ ------ DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ------------ ------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------. ----------------- ------------- - -------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 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 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 becomes je t;toorkman's Compensation laws of California." 'S Signed - ------------------------------------------------------ Owner BY --- - - ----------------------------------------------------------- Title ----------------------------------- ------------------------------------ (If other than ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. �. d- --------------------------------------. DATE ---7---Q. ------------ BUILDING PERMIT ISSUED ---------------------------------- .... -- -------------------- ----------------------DATE --------------------------------........... ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- -------------------------------------------------------------------------------------------------- ------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- ---- - -- - --------------- + ' ----------- Final Inspection by: .___ __ -�J -------------------- ---------- ------ - --- ---- --- - - -- - --- - - -----------------------------------------------------Date -�{--------'eta----------- - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.