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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..�-? , This (Complete in Triplicate) ' Date Issued --------_----------_._---------------------------------- Permit Expires 1 Year From Date Issued j] Application is hereby made to the San Joaquin Local Health District for a perh,�it to construct and Winstall the work herein described. This application is made in compliance with County Ordinance.No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ------ ------ ....................CENSUS TRACT ------------L-1-------- Owner's Name ------- EQ - ----- _t_ 1'}-------------------------------- -------------Phone ------------------------------- - Address ------7-;Z 2�.--- ---------\18-r\1------- City --- _r.1q_L_0.1 Contractor's Name _ .` ------------------ ----------------------------------License # ------ ------ Phone ------------------------- Installation will serve: Residence partment House❑ Commercial OTrailer Court V1 Motel ❑Other ----------- -- ------------------ r A , Number of living units:.__ ___-__-- Number of bedrooms --_—_Garbage Grinder'_.IVV... Lot Size AC KEFl_(!��.___.___- Water Supply: Public System and-name' - Private -------------------------------- Character of soil to a depth of 3 feet: Sand' Silt❑ Gay E] Peat E] Sandy Loam E] 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,) i PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth -------------------------- 11) _Capacity - - ------- ---- -- Type -------------------- Material--- ---- No. Compartments ------------- Distance ----- •---Distance to� nearest: Well --------------------------- ________Foundation ___ _ Prop. Line _________-..._......__ a LEACHING LINE [ ] No. of Lines ------------------------ Length of each. line--------------._z- -------- Total Length ---.__.____-___________.____ 'D' Box ------------ Type Filter Material ----------- Depth Filter Material -------------------------------------------- Distance to nearest: Well -------------__ -__-_-_ Foundation ---------------- Property Line ---------._______--__ - SEEPAGE PIT Depth Diameter ----------------! NumbeY --._.-t._-_________________ Rock Filled Yes No [ ] p ❑ Water Table Depth -------- ` --------- ------- - --,.--..Rock Size ---------------------- Distance to nearest: Well -----------------------------------------Foundation -------------------- Prop. Line ------.-----_---- REPAIR./ADDITION(Prev. Sanitation Permit# ----------- ------------ --=--- !- ' Date ------------ Septic Tank�(SpeGify Requirements) ------------ :` �.1_- C--- -------------------------- --------------------------- Disposal Field (Specify Requirements) __P?Q ---16%'x.4— �P-IRF__FA-2*5-------0-I--V-C-fir r �� —----------------- _P_tST___ Qk " C'�N. CT ' ?-- _._ K_� _T-[dU 1 _1 1( 1"t :�--- jQ1 t ------F L�!-- --- iq_(313 W_T 7 7 7 7-- ------------------------ --------------------- :_ {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.acc`ordance 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: _,, iJI "I certify tW in the p rformanc of he work f hich this permit is issued, I shall not employ`any petson in such manner as to b come subjec o Workman ompensa o laws of California." Sid -------- -------- -- - ---------------------------- Owner By --------- -------------------------------------- ------------ Title --------------- ------- _ (If other than owner) FOR DEPARTMENT USE ONLY BUILDING PERMIT ISSUED -------------------- ----------------------------------- --------------------------•-- -=---- -_---- DATE _=_----7--- _- `�----`--�-�J--- APPLICATION ACCEPTED BY --------t-� -0— ------------------------------------------------------------- ----- -- --DATE 1-----------•-- ----- - --------------- ADDITIONAL COMMENTS _.. - ---------------------- ----=-------- ----------------------------------------------=---------- - -------------- --------------- _.. ------------- ------- -- -- - _. : --------- - --- - -- -- --- ---- - -- --- ------------- - ---- Final Inspec ' Date - .__ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M