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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / 9 (Complete in Triplicate) Perm _----------------------- This Permit Expires 1 Year From Date Issued Date Issued _4_95 f 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. d existing Rules and Regulations: JOB ADDRESS/LOCATIO ��r------A,------- ------ NSUS TRACT ------------------• ------ Owner's Name _ ' ------- Phone -------- -----------------------_-- Address ------- ----------- ------- ------------ City � ----------------- ------ License # .ZZQv/.P,'Phone Contractor's Name -------- dlt, --.-:____-11� - Installation will serve: Residence QrApartment House,❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other ------------ ------------------------------- Number of living units:_---!/_ Number of bedrooms --a_____Garbage GrinderW�____ Lot Sized/f' Water Supply: Public System and name -------- __-- .=-.-- -S G - --- -----------------------------------------------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/`5/"71V4 ize------------------------------------------------ Liquid Depth -------------------------- v Capacity -------------------- Type --------------------- Material---------------------- No. Compartments ----------------- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- LEACHING LINE ] No. of Lines ------1__------------- Length of each line---------KO Total Length -______________ 'D' Box __Q___gType Filter Material � Filter Material ___��_______._ __._ Distance tt«qqo.nearest: Well,l�d__�-A&Foundation _.__/__ ___________ Property Line ____I_____ ..--.... SEEPAGE PIT Depth __ea�_`� _______ Diameter� __�_rNumber .-----------�.--------- Rock Filled Yes ' No ❑ .__ Water Table Depth ----------r'� -----------------------------Rock Size ----v-PT-----------------•---- Distance to nearest: Well Foundation _/ .......... Prop. Line ______ _y__ REPAIR/ADDITION(Prev. Sanitation Permit# _______ ------------------------------------ Date -----------------------------------I Septic Tank (Specify Requirements) -----------�_ -----------A?e-/c�_ ------------------------------------------•- ---- ---------------------- Disposal Field (Specify Requirements) ----,727------------ ----------- ��__-__.____ !' -----'-,r__-- --------------------------------------------------- ---------------------------- ----------------------------------- ----------------- (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. Nome owner or licen- sed agents signature certifies the following: "1 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 BY �� '-c.' ��----- -- - = Title C 4 ----------- (If other than owner) FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY � U �� ---------------------- DATE ---- --Z- '�` . ��lV BUILDING PERMIT ISSUED --------------------------------------- --- - ----DATE ----------------- ---------------------- -------------------------------------------------------------- ADDITIONAL COMMENTS --------- --------------------------------------------------- ------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ - -------------------------------------T_ -- - -- - -- ------------ - ------------------ - -- --------------------------------- -- ---------- ----- - -- Final Inspection by: ----- ----- - -- ----------------- ------------------- ------- - --------.Date --- -- � - --'----- # ------- SAN' OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M