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.,FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / • -------------------- t =------- =1�>/(Complete in Triplicate) Permit No: - ----------------------------------------- DateIssued?\ ___w_____-___ This Permit Expires 1 Year From Date Issued _ Applicati6n is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein describe This a plication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB A D 5 AT10 ' ' `I o`----- ,�-- --"`---�c------ CENSUS TRACT _------ Owner s Name -----.Phoney ---Zo Z9------------ A ----------- Address = f X;- ------------------------ --- City rL p Contractor's Name 5 ` License # _ //-------- Phone Installation will serve: Residence ❑ Apartment��H�ouse❑ Commercial ❑Trailer Court l❑ Motel E]Other ----- v`_AA .-ff_-e - Number of living units:------------ Number of bedrooms ------------Garbage Grinder - ----- �LLot Size -------------------------------------------- Water Supply: Public System and name ------- ------------------------- -------------- - ---- �� Private E] Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam A 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.) I' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) - PACKAGE TREATMENT [ ] SEPTIC TANK' Size ----��-_-p-.......------------------ Liquid Depth -- 5-- ........ -_ ,1 �------ Material No. Compartments --- ------•---• �- Capacity -----,-- Type - ------------ -Com' -`_ -------- Distance to nearest: Well --------------------- Foundation ---410--------------- Prop. Line ---- � `.--__-- LEACHING LINE No. of Lines --------(----------- Length of each line-------��--•-- ------ Total Length ----3d................. 'D' Box ------------ Type Filter Material __/24��____Depth Filter Material --_---_4c---------------------------- Distance to nearest::Well ------------------------ Foundation ---/-0-r.---------- Property Line --- .-_-----._.__- rRock Filled Yes)K No ❑-------- Rh SEEPAGE PW [ i Depth .--��_____----- Diameter ---------------- Number _-__---- ---__-/_ . - 5u s"'p r d1 Water Table Depth ------------------------------------------------Rock Size `7� ��C/ rr Distance to nearest: Well ----------------------------------------Foundation !_. Prop. Line-__-....._-----..-..- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ----------------------------------------------------- -----------------------------------------------------...--- ---------------------------- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------- ------ ------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) _ I hereby certify that I 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 become subject to Workman's Compensation laws of California." Signed ------------------- -- ---- ----- ------- Owner BYf ------------------------------------------ Title ------- -------------------------------------------------- ( t`6the t an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ..�r�.� —---------------------------------------------------- DATE 1� •�'�`� BUILDING PERMIT ISSUED ---- ----------r----- DATE ------.. --IL =------------------------ ADDITIONAL COMMENTS - 4 -_-- S - ----------------------------------------------------------------------------------------------------- --------------------- ------- ------------- - ------------------------------------------------------- - -------------------------------- -------------------------------------------------------------- -------- ------ -- Final Inspection by: --- Date- ate ---'�-'- .-! SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M