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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT:f ----- (Complete in Triplicate) Permit No- �_----------------- -- ---------------------------------------- --_---_____ 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 qhe work herein described. This application is mad in cn liance with County Ordinance No. 549 and existing Rules an Regulations: JOB ADDRESS/LO ION - �- _-nl �- i------ vA4�s�,-- Owner's Name --- if2� C i d _�hl ----------------- -------Phone = 7 ' Address ------�Z- ----------A ---V-F,- P._L_T/9_------- Cit ��_��_ 7_�Gr�? Y -------- Contractor's Name -- ��:----_-.-6o_�_ {!__` -----------------------------------License #27.c3WW -- Phone - Installation will serve: Residence ® Apartment House-E] Commercial ❑Trailer Court ;❑ Motel ❑ Other ------------------------------ ------------- q Number of living units:....I------ Number of bedrooms ________Garbage Grinder ___________ Lot Size ./' f'1 ' ----___________. Water Supply: Public System and name -------------------------------•-•------------ ------ ---------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'W Silt Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ____________ if yes,type ____________________________ (Plot plan, showing size of lot, location of system in ation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: JNo septic tank or seepa pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK'[ Size - JV--------- Liquid Depth __/�-_____________ r Capacity /rw-- ---______ Type _ Material No. Compartments __ ._____-_-__--- 00 r __Foundation __�_p/----- stance to nearest: Well ______ ___________________ ______ Prop. Line _t5________________ '11 LEACHING LINE No. of Lines f s 11) -.--�-------------- Length of each line---��----_------- -_--- Total Length -------------...._.__ ' 'D' Box ------------ Type Filter Material _I?IpC:K_____.Depth Filter Material _1_fr_ ------------------_------------ 40 Distance to nearest: Well ____-6_D_________ Foundation -/;!-/-------------- Property Line -------------------- SEEPAGE ------------------ SEEPAGE PIT [ ] Depth __________________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No O K Water Table Depth ------------------------------------- ----------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _______-__.--_-_-_--__ ` REPAIR/ADDITION(Prev. Sanitation Permit# ________ _______ ____________ Date ----------------------------------) SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------------------------------------------•--•- Disposal Field (Specify Requirements) --------------------- ----------- ------------------------------------ -------------------------------------------------------------------------- ----------------- ------------------------------------------------------------------------------=------------------------ --------------------- ----------------- --- - - - -------------------------------------------------------------------------------------------------------------------- (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 such manner as to become subject to Workan's Compen3ation laws of California." Signed -- -- - ---- ----- - --- ---------------------- Y Own er Title By ------- - --- ---- --- - ------ other than owner) �� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -779,0- ----------------------------------------------------------------------------- DATE �i� . BUILDING PERMIT ISSUED ------------ - - ------------------------ -------------------------------------•--------DATE ------ ------ ----------------------- ADDITIONAL COMMENTS -- ----- -- ------ -- -------- - - --------- -------------------- ------- ------------ -------- ---------- ------------------------ - -- ------``------------------- - ---------------------------------------------- 1(J Final Inspection ) R - ----I--------------------------Date - � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M