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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------- ------------I`--- (Complete in Triplicate) Permit No: ....:T47-71_ _ ___----------------------------------------------- -I!_____ This Permit Expires I Year From Date Issued Date Issued __._ I. oql— rt7_o Application is hereby mad 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. 549 and existing Rules and Regulations. - JOB ADDRESS/LOCATION! --' -=I __-%-- a__-. _-- --- ✓.fn/� r -/1- NSU5 TRACT ---f/-----•----------- Owner's Name .------ —- ------- = ------------- -----= --------- --------Phone JF-Y70---------- Address -�° 1 fi City ----------------------------------------------------------- Contractor s Name _..- c--------------------------- ---- ------License # ---------.-------------- Phone ------------------------------ Installation will serve: Residence ITJ M Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ---------------------------------------•--•- Number of living units:---/L----_._ Number of bedrooms _ ---Garbage Grinder ------------ Lot Sizef - - -- ----____________________ Water Supply: Public Systel,.., and name -------------------------------------------------------------------- ------------- ----------------------Private ❑ Character of soil to.o depth of 3 feet: Sand'❑ Sift E] Clay E] Peat❑ Sandy Loam' Clay Loam E] Hdrdpan ❑ Adobe�❑ Fill Material ___- _If yes,-type (Plot plan, showing size o� 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 [ ]if SEPTIC TANK;F l Size-�v-f__9 ___.______.\----- Liquid Depth - _________________ rn :I Q ,. „ Capacity �-'�'------____-- Type ________________ Material--- No. Compartments ----------------_-•_-- Distance to nearest: Well -------------------------Foundation 1.0-14------------ Prop. Line __________ LEACHING LINE No. of Lines _�___ 0-_-----_ ,�'J _ Length of each line______ _.---- Total Length A�_O........ i 'D'I1Box _)/&9----- Type Filter Material . :__ ------Depth Filter Material __- - Distance to nearest: Well ___ Q--------------- Foundation /_a_'_._____ S_.____ Property Line --------- .SEEPAGE PIT [ ] Depth ___________________ Diameter ---------------- Number ___________ -------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size ----------------------•--------- I Distance to nearest: Well ______________________________________Foundation -------------------- Prop. Line --__--____--__-_-____. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________} SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------------------------•---------------------------- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- 11 --- ------ ---- -------------------------------------------------------- ------ ------ -------------------------------------------- -- ------------------------------------------------ -- ---------------------------------------- --------------------------------------------------------------------------------------------- - �(-Draw,existing and-required addition-on-reverse-side) ��•_+ �^ -`^•-�_ I hereby certify that I hav' 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 at in perfor�i ance'of the work for which this permit is issued, I shall not employ any person in such manner as to be o e s ect to rkman's Compensation laws of California." �E. Signed -- - --- ---- -- ---- --`'"II- Owner ----------- -- -------------------------------------- BY ---- - ----------------------------- ---------------------------- ----------------- Title ------------------- ------------- (If other than`owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ---- --- ----------------------•----------------------------------------. DATE l- � ---------------- BUILDING PERMIT ISSUED '' ------,---.------------------- - ------------ - ---------DATE ------------------------------------------- ADDITIONALCOMMENTS -------------------------------------- ----------------------------;----------------- ----------------------------------------- --------------------------- ------------=------------------- ,�_ ,;�t , -� - -------- ------ r --------------------- ---------------• ------- , -------------------------------- _i: VFinal Inspection by: ---------- ]( --.Date ------------------- .-------------- SAN _ __. _SAN JOAQUIN LOCAL HEALTH -DISTRICT E. H. 9 1-'b8 Rev. 5M 1 � .