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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --- (Gomplete in Triplicate) ------------- ---------- ------ -3� - Date Issued This Permit Expires 1 Year From 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 ex'iissting'des and.Regulations. ;9 I JOB ADDRESS/LOCATION F ---------------------------CENSUS TRACT -------------- ------------ Owner's Name -------Phone '' .. 6 v `Ci# ---------------------------------- ----------- Address ' Contractor's Name --- u,t �41icense # _ ?, [!----- Phoney Installation will serve:—- - Residence AparfMent House,0-Commercial ❑Trailer Cour-t_;0--.-- -- --- .+ 1° Motel ❑Other'---------------------------------------.-- f j n Number of livingunits______ _____ Number of bedrooms -___9�`�Garbage Grinder -__ _-- Lo ----------- sz'�- f Water Supply: Public System and name ------------- ------ `- '_ = = ''``�` Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑�', Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ i� 1 Hardpan ElAdobe X Fill Material------------- if yes, type ------------------- I+ (Plot plan, showing i size of lot, location hof system,.in relafiion 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 [ I SEPTIC TANK'f 3 Size------------------------- ---------------------- Liquid Depth ------------------------I! o� Capacity -- ------=--------- Type ---------------:---- Material--- ----------------- No. Compartments Distance to nearest: Well -----------------------------------Foundation ---------- ------ Prop. Line ----------------.. --- #� LEACHING LINE [ ] R 1 t � Length of each line -------------------------- Total Length :__._-----------------=---- 1 No, of'Lines s--- ------------ ---- 9 �,�._..,..._. - .,,�.. D' Box ---_--___.-- Type Filter Material -`-------------------Depth FilterJMgterial ------------------------------•-----•------- Distance - , " 1 D ---- --- Foundation ------- Property Line --------------------- Distance to nearest: Well -- ------ --- Number . ' _---'___._Rock,Filled Yes ❑ No ❑ SEEPAGE PIT [ ] ; Depth --- -------------- Diameter ------____ --- 4 Water Table Depth -----------------------------------------------Rock Size ---------- '---------- I ' s --�' Pro Line -------------------- Distance to nearest: Well ----------------------------------------.Foundation _______________ P REPAIR/ADDITION(Prev. Sanitation`Permit S# ----------------------------4 Date ---_---_-------------------- j - 1' , ---------------i- -•- it Septic Tank IS ecif Requirements)„y: - =r O Disposal Field (Specify Requirements) ----- ----- -- / P---- . Ag�Y;J t ------------- ---------------------------------------------------------------------- C c„ �. f ' �F R I hereby cerci that I have prep (Draw existing and required addition ori reverse side) y certify � b erred this application and.,that the work:will be done in accordance with San Joaquin Laws, and Rules and Regulations of'th San Joaquin Local Health District. Home owner or licen- County Ordinances, State L f q t i sed agents signature certifies the following: i "I certify that in the performance of the work.for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compeniption laws of California.” [ [ Signed --- -- ---- ------ -------�� Owner , 9 - - ----------- ii f title .." ------------ ------- h BY ----- - --------- ' li (If other n owner) I; FOR DEPARTMENT USE ONLY i �L1 � --- ---- APPLICATION ACCEPTED-BY.---- ---=--=- -=- --==- ----:`-=-:_--=-- ._v,_ ------------=--------- B ------- DATE __.. ' BUILDING PERMIT ISSUED __.-- -_ _. ------DATE ADDITIONAL COMMENTS -------------------- ------------------------------------------------------------------------------------------------- ----------------------'_. -------------------------------------------- ---------- Y -------------- ---------- - . i ,. Final Inspection b ------------- ------------- -----Date --- ------- ---------------------- SAN --- - ----- -'�----- SAN JOAQUIN LOCAL HEALTH DISTRICT ; t E. H. 9 1-'b8 Rev. 5M _