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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT v� (Coimplete in-Triplicate) I- Permit No. .��1__.�J_ -_______------------------------------_------------ -- This Permit Expires 1 Year From Date Issued 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 mane in compliance with County Ordinance No. 559 and a Rules and Regulations: JOB ADDRESS/LOCATION .__ � S_2_ . /_y-__ - I�j ��Y------- ----------1----- CENSUS TRACT __-=: -----__'.._......_ -- Owner's Name ✓f :�-----�----1✓j�C_/�,�d�------ - --------- -- - --- -- ------------------ --- - -- - --Phone -- Address _ � - ---i City # ' - © Contractor's Name _-- �= t,- - -1--'��----------------------------------License # p - /_f-�J_ Phone _1f_ �_" .�.cf ^Y Installation will serve: Residence ❑Apartment House❑ Commercial❑Trailer Court ❑ /f Motel ❑Other------------------------------------------- Number -----------------------------------------Number of livingunits:------- Number of bedrooms ____________Garbage Grinder Lot Size ______ Water Supply: Public•System hand name ----------------------•--------------------------------------- ----------------------------------------------Private Character of soil to aidepth of-3 feet Silt❑ Clay ❑ Peat ❑-,. Sandy Loam -❑ Clay Loam ❑ �..- ,� - Hardpan ❑ Adobe '❑ Fill Material -IV-(1____ If yes,type ---------------------------- 3 (Piot 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 r F�. ( p o seepage pit permitted if.public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK Size------------- _ _____.- [ � � [ � ----------------�- -- Liquid Depth -------------------------- l Capacty' , _________________ Type MaterialFoundatian Nos Compcsrtments *d Distance to nearest: Well _______________.Prop. Line -_-_-_____-__-________ � . LEACHING LINE [ ] No. of Lines ------------------------ Length of each line------ ----------- :Total Length ,---------------------------- � i D' Box --- -------- Type Filter Material --------------------Depth Filter M`ateriai --_ - --------------,-----------_-----_-__-- � Distance to nearest: �Diameter ___ __________ _Foundation � {��`_i'� ,:Praperty Line. -____.__..______._.:.___ 1 SEEPAGE PIT [ ] Depth --------------___tl Rock Filled Yes [{ No 0 Rock Sizei Water Table Depth -------------- --------------------------------- Size ---=----- ------------ Distance ------- ---•--- .--Foundation _.____ i p. Disfiance to nearest: Well -------------------------------•-- -- f-t--}--------- Pro Line ---•--------.:....--.- REI}AIR/ADDITION{Prev, Sanitation Permit r# ------------------------------------------- Date ---------------- i'___t________-) , ; r _ K Septic Tank (Specify"Requirements) _ } ---- 8©-----Frt1L--- ]9_N_h__TO______7(U_ R - _ 'I STI��- CZ3NC 7� - ----------------------- •F-- - I .Q$G , Disposal Field {Specify Requirements) ___�_�__��__________��J�yQ�. Q- /� .�__--/.Lll�!`Q______-- i€> ------------------------------------ - ----------------- ., - ----------------=�--------------------=-------------==�--=f----------------°-----'=----------------------- =rte'=-----------�-- - _.� . .. ---- • � I{Draw existing and required addition on reverse side) i I .hereby .certify that I have prepaeed this 'application and that the work will be donefini.accordance with San Joaquin County Oidiri'ances, State Laws, 'and Rules and Regulations of the San Joaquin Local He6lfg District. Homeowner or licen- sed agentssignature certifies the following: i F .%"1 certifyjthaf in the performance of the work for which this permit is issued, I shall not employ any person_ in such manner 1 as to become subject to Work 's lifo Compensation laws of Carnia.-"-- -'•� Signed + caner 3 O —_t BY = - -- ------ --- ---------------------- Title ---------------------------- ------------------------------------------ if other th n a ner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ay ------ ----------------------=----=---------------------------------------. DATE ------ 0_^ _.- BUILDING PERMIT ISSUED ------------ -------- -----------------------=-------r-------------- -------------------------------DATE ------------------------- -------------- ADDITIONAL COMMENTS -------- ------------------------------------------------------ - •�a -- ------ -----=----------------------- = --------------------------------------------------------------------------------- ------------- ---------------------- ------ ---- ------- ---- - - -- =_ °-' Jt` Final Inspecti : _ -------- --- ---- ------------------------Date ---------�.�-----�_ __ ------=•------ ; SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.9 1-'68 Rev. 5M... 0 - ,