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FOR OFF,IC USE.: APPLICATION FOR `SANITATION PERMIT wVia. 1 ------------ ----- --•--- -_-•-------- -------- �� -Permit No: (Comp!etee 9 E Triplicate} s f,; F -- -------------------------------------------------------------.-- w, ,r -. �f�° Date Issued -- -- �- - -- '-4� ,This Permit Ex ires 1 Year F€om,Date Issued Application is hereby made to the San Joaquin Local-Heal' 'Distr ct for, a permit to construct and install the work herein described. This application is made in compliance with Countyrdinance No. 549 and existing Rules' and Regulations: JOB ADDRESS/LOCATION `a OR .G--F �?C`----CENSUS TRACT ----�---Y�------ --Phone ------------------------------------ Owner's Name ---------------F -- s ----------. City ---- Address ` = = 9-51-3- ------ ------- �-- ---- -------------- - Contractor s Name -----�� .�- -- ------------------------- -- - ----- .License #;----------------------- Phone Installation will serve: w Residence Apartment Housw(j Commercial ❑Trailer Court ❑ r ., _ ---- ----- i Motel E]Other _.-- < Number of living units:-_-- ----- Number of bedrooms _-- —=Garbage Grinder --�f�--- Lot Size ---'- - �) A-6 ------- Water Supply: Public System and name ----------------- --[5-`------f��' - = ---: Private ®� Character of soil to a depth of 3 feet: Sand❑ Silt❑ -Clay ❑ Peat Sandy Loam Clay Loam :❑ HardpanJZ - Fill Material _ .- _`'='_ If yes,type ----------------------------- [Plot plan, showing size of lot, location of system in relation to wells, buildings,'efc.�must be placed- on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet] `n PACKAGE TREATMENT [ ] SEPTIC TANK![ ] Size------------- ='�'------------------- .--, .Lic}uid Depth Capacity Type Material ------------------- No.` Compartments (n Did#ci"dlf!�Vnearesfi: Well 1 -------------Foundation ---------- -- ........ Prop. Line ---------- ------ 1 nc LEACHING LINE .._ Len No [ ] . of Lines --------------------- Length of each line---------------------------�Total Length ---------------------------- � , 'D' Box ---"-------- Type Filter Material --------------------Depth Filter Mate.ridl ---------------------- Distance to nearest: Well ------------------------ Foundation --------------- Property Line. -----------------•------ SEEPAGE PIT [ ] Depth - Diameter ..-- Number ---------------- ------}-_ Rock Filled Yes ❑ No - ..r Water Table Depth ----------;` ------------------ ' ,. " - Rack Size '----- --�{ ---------- ...------- f Distance to nearest: earest:_We'll -------------------------------------- -Foun-dation ------_-- ---"-�--- !Prop. Line Al REPAIR/ADDITION(Prev. Sanitation Pemt# i ---.--] '--------_-^-��-�� •-=---�) Septic Tank (Specify Requirements) . L-_j - t h it -- { - t Disposal Field (Specify Requirements) COV..� � -- - --- I - F - -�_- 4i - -;w j -_--4- N� 4-------- ------ ------------------------ wl-per application n a d that - - -- -- -- --------------------------------------- ------------------ - w .... .._ ....r (Draw existingand required addition on rever�'esii�'e I hereby certify that I have prepared this pp t the work will be done in accarda""rice with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health D'sstricf:)Home owner or licen- sed agents signature certifies the following: t "I certify that in the performance of the work for hick this permit is issued, I shall not employ any person in such manner as to be a ject to W an's Co ensatio law`s of:California." Owner I Signe ----------- - - J — Title - ------------------------------------------ ---------------------------- (If other than owner) FOR DEPARTMENT USE ONLY DATE ...l1�i ` 0- 7Dr APPLICATION ACCEPTED BY r i----------�p _ .---DATE i BUILDiNG'PERMIT"ISSUED" `------ ----- ADDITIONAL COMMENTS ---------- -=+_z-:----f_--r1:-------- -- ---------- - -- -- - - . == ------------ ---- ------------------- ------- --------------------- - -- ------------------------ }1 ......................................... ...-- .-._ ---- __________ _____ __ --- ------------ --M .> ' ---::------- ----- - ------- Date 4r Final Inspectio - - - - J ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E.H. 9 1-'66Rev. 5M