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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a9 - - -- ------��-�-�----��--=�-�-- Permit No, ---- /Q ,� (Complete in Triplicate) ----------------- - -------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued 1 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/L CATION _4_ ¢ ___. _ _ _____------------------ _s _.____..____CENSUS TRACT Owner's Name - ,_ � , Phone ------------------------------------ �/ Asn t Address -----------3-� 7` 00en-----�-1--- --- --------- --- City - - - •---•-•-•-•---- Contractor's No __________ ____ _ Phone ��"� p 13= -----�? Ti -(License # _�r 3Y Installation will serve: esidence ❑ Apartment House ❑ Commercial.:❑Trailer Court ;❑ Motel ❑ Other ------------ - -- --------------- Number of living units:----/----- Number of bedrooms-,_-__f-\__G rbage GO der -.__- ._-- - Lot Size I 4� n �1 . Water Supply: Public System and n'ame.__- `- -- e��ri.�.ca,.z_ _. - --- '---------------------------------------------Private ❑ Character of soil to a depth of 3 feet Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam.❑ i p CCO. 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: {N septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKg Size-/,Z- ------------- Liquid Depth -----5Z- --'v Capacity L_Z.QoV------ Type 1-- ____ Material_ e..4 "'___ No. Compartments -----Z............ t Distance to nearest: Well tA-0-11-6--------------------- Prop. Line _______ 11 LEACHING LINE No, of Lines -- ------------- Length of each line_____ _!�-___---__--_-___ Total Length --------------------00 , e' 'D' Box - T e Filter Material Depth Filter Material `..._.-. . _ i Type r; p f -------------------// Distance to nearest: Well ra_�t.�__:___:__ 'Foundationp _____._.___ Property Line -------- - SEEPAGE PIT Depth ` ___._ Diameter Z-5-------Number.,___ ____________-Rock Filled YesX No ❑' F Water Table Depth ----------- -----'------- i_k%�_Rock Size -------------------------------- '} tDistance to'nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------- ------- REPAIR/ADDITION{Prey Sanitation Permit# -------- -----r-----------------_`___ __ { Date __-' _______________________________ Septic Tank (Spe-cify Requirements) ------------------ ----- t- ---- ----- ) - t - _ Disposal Field (Specify Require-m- ents) -------------------------------------------------------------------- --- ------------------------------------------------------- ------------ -------------------'-C--�--x-s---I----------------e-.----+--------r----•---------------------------------------------1'-- -- -- {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 lien- u sed agents signature certifies the following: P "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 s iect to Workma ' Compensation laws of California." ne g " Si � Aj� . - -- , r� ----- B , Y ----------------------------------------- - ---�� - - --- - Title ------------------------------------------------ (If other than owner) . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE ---f--4'�----4� ----------------- --- ------- - --- ------------------------------------------ ----------------------- BUILDINGPERMIT ISSUED -------- ---- I---------------- ---------------------------------------------DATE -.----------------------------------------- ADDITIONAL COMMENTS ---- -- ----- - ---------------------------- ----------------------- ----- --- ------------ - --------------------------- --------------- ------------------------------------------------. ---• ---°--'` • -------------------------------------------------------- ----------------------------------------------------------------------------------- --------------------------- --------- -- Inspection by: ,_ -------------- --------- i -- ----- ------ - -- -------- ----------- - -- ------- -- ------------------------------------------------------------------------------------------- 6 =------ ---- ------- -- --- --------------------------------------------------------------------------.Date _...- ------------ ' ----------- -- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M