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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit ----------------------------------- ----------------- (Complete in Triplicate) - -----=------ -------- --------------- Date Issued --------------- - -------- ----------------------------------- Y This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application.,is-made incompliance with County Ordinance No. 549 and existing Rules and Regulations- VV I egulations:Vv..n.fl. ,. . Z� 240 - 1 ? a �' CENSUS TRACT �� JOB ADDRESS/LOCATION _ - a Owner's Name y - ------Phone -------- -----°--------- Ac L Address __.�f-fes f= e ------------- Cit ----------- ---------------- ---------- Contractor's Name 'G �9---z l-1`� ------.License # `7 -9--Lr Phone _,F,43-_L_`?--- - 9 � �* Installation will serve: Residence �Apartment Hous e❑ Commercial:❑Trailer Court ;El Motel ❑Other ------- ------------------------------------ Number ----------=="--------------- -=Number of living units:___- ------ Number of bedrooms ---3-----Garbage Grinder ------------ Lot Size 1 1?_7t-L -a----------------- Water -- ---•------Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private 1-7 Character ----------------------------- ---------------------------------------•------ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam:❑ k. _Hardpan [z] i�Adobe_E1;::FilkMaterial � _ ----If yes,-typ - --------- - {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] `.. k NEW INSTALLATION- (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r L _ SEPTIC TANK' Size---- ___ __- �------- PACKAGE TREATMENT ( ] [ ] -'Y,2.-�-�- Liquid Depth ---'�----- ---•---- . Capacity f_a�0--•-- Type P'��L' Material_ ,o c>'t �No. Compartments - --- 5. 01 Distance to nearest: Well ----- c�-d-------------------Foundation ----/V---- Prop. Line �6 ___ Total Length /b d LEACHING LINE [ ] No. of Lines -----9--------------- Length of each line____--�-._--- --- --- 'D' Box ------__---- Type Filter Material 12e�c-_----Depth Filter Material __/ - ----------------- ---------- 'D' y Founda#ian Property# nearest: Well ------ -- -� Pro a Line. ------------------ Distance-to, • De th ____4'xjoxao _° ' Diameter ________ __-__ Number ____------_�--- ---------- Rock Filled Yes No 0�� [ l p Fivren Eden Water Table Depth ---------50--t--------------------------Rock Size _41jac------------- Distance to nearest: Well ---Ld7a---------------------------Foundation ----------- Prop. Line ----5 �J REPAIR/ADDITION(Prev. Sanitation Permit# _------------------- ----------- - ------ Date -------- --- --------------------) -- Septic Tank (Specify Requirements) -------------------- - Disposal Field (Specify Requirements) -------- -------------------------------------------------------------------------------------------- ------ ------------------------ __ _ - =—� _"`"(Draw existin and re aired addition on reverse side) 1 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. H_onie owner or licen- sed agents signature certifies the following: i • - - "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 Workman's Compensation laws of California." i Owner Signed -- ------- t ------------ ---------------- _ /////JpJjj�11///J ------ Title ----------------------- --------------- ----------------- +, (If other than owned �-- -- } FOR DEPARTMENT U LY ] '~ � ' � -_. _/��a�'�� ---- APPLICATION ACCEPTED BY --------------------------------- -------------- --------- DATE ----------- ---- BUILDING PERMIT ISSUED ------------------------- --- ---------- ---------------- -=- r-"- -- -------- -DATE ------=- --------- --------- ----------- - ADDITIONAL COMMENTS ------------------------------ ------ - ------- --------------------- -_-__, __ .._.�.-_ '=•f i --------------------------- _.. _ .. t -------- -- --- ------ ----------------------------------------------------- ---------- -------------------- - t� �?�''��`bate {j =��t�___-�--t __ --- - - - - Final Inspection b a - -------------- pY 'b SAN JOAQUIN LOCAL HEALTH DISTRICT 5 E. H. 9 1268 Rev. 5M