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FOR OFFICE USE: APPATION FOR SANITATION PERMIT Permit No.C��= f _ ---------,•------------------- (Complete in Triplicate) ----------------------------------- Date Issued ._— - This Permit Expires 1 Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is madel.in compliance with County Ordinance No. 549 and existing Rules and Regulations: --- ------------------CENSUS TRACT J08 ADDRESS/LOCATION _�l�------ ---�-�,---- =-�--f4��-------- ----- --------- - - Owner's Name ....... Q ?l OAS -------------------------------- -------------------------- ----------------Phone £� rr�� ti Address .a� S k _4:/- , V�------------------------------------ 5 ---- ----------------------------- City t } Contractor's Name 1 --- �t 5 ------------ f Phone ----------License #�7- - Installation will serve: Residence g�-Apartment House❑ Commercial ❑Trail 6r Court ❑ w Wotel ❑Other _ --------- Number - i Number of living units:--__ ------ Number of bedrooms ----3___.__Garbage Grinder _-Lys- Lot Size,_hd-P-�- ��------- ...... A _ -� �-- � Water Supply: Public System and name --------------- ------- --- -------------- - --------------------- ------------ Private F1► � a Character of soil to a depth of 3 feet: Sand'El Silt F1 Clay .❑ Peat[I Sandy Loam ❑ Clay Loam �Ha dpat .[] Adobe X 11 Material ----------- 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 [ ] Size------------------------------------------------ Liquid Depth ---------------------.----- Ca acit T e ------------------- Material---------------------- No. Compartments = Capacity Yp Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -------- ------------- LEACHING LINE [ I No. of Lines ------------------------ Length of each line- -------------------------- Total Length -------------- ------ 'D' Box ------------ Type Filter'Material --------------------Depth Filter Materia ------------------------------•----------- Distance to nearest: Well f----------- -q-:------ Foundation ------- q-----i------ Property Line. ------------------•-_-- 1 SEEPAGE PIT [ ] Depth -------------- Diameter Number -------------____ _---___ Rock Filled Yes '0 No id - - ------------- - -------------- Water Table Depth Rock Size:-------- ------------- p lt" Distance to nearest: Well ----------------------------------------Foundation ----------------- Prop. Line -----•------- -------- I REPAIR/ADDITION(Frau. Sanitation Permit# - --------------------------- Date _- --------------------------- Septic Tank (Specify Requirements) --____---. __ ----------------------------- Disposal _ ---- - ------------------------------------------------------------------------ - ------------- Disposal Field (Specify Requirements) -- --'- `--------------------------Z,, �_� ' l '�� ---- �- € - ------------------------------------------------------------------------- i.l I (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 sorb manner f as to becom sub' t W man's Compensation laws of California." Signed . -- -------------------------------- Owner FTitle -- ------------ -------------------------- ---------------------------- BY ------------- -- --------------------------------------------- -- (If other than owner); ' FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ---------- ---'--- ---- '�v --------------------------------- DATE -- ------ --------------------------------------- ---- 4. BUILDING PERMIT ISSUED ----------- ADDITIONAL ---------I DATE - ADDITIONALCOMMENTS --------------------------------------------------------- -------------------------I ----------- ---------------------------------I--------------------------------------------- ------------- ---------------------------- -------------------------- ---------- --- - --------------------------------------- ---------- -------- ----•------- ------------------------------------------- ---------------------- Date _. ------6 Final Inspection b �1� Y ° U �$ SAN JOAQUIN LOCAL HEALTH DISTRICT , ). E. H. 9 1-'b8 Rev. 5M. ' "`�'