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FOR OFFICE USE:J APPLICATION FOR SANITATION PERMIT �� / 0 Permit No- ------------ -------- --` --- (Complete in Triplicate) _ Date issued/,—,_-_G____ ____________________---------------------------- ------ - - This Permit Expires 1 Year From 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 made in compliance with County Ordinance No. 549 and. existing Rules and Regulations: JOB ADDRESS/LOCATION ._--.-- -- - > - -------- / 'IYlENSUS TRACT -----------/- --• A ! ---- ------------------------------------ Phone_9. 1-P� -lid Owner's Name ._ SLY-/ /Vt Cir - Address _60-5-7---- - -------------------------------------------- ------ -------------------------------- City �7`Prt7Z21)1---------------------- - ----- --------- /C ------License # -17-7.-�� Phone ��?� Contractor's Name .-f��--s- -••-��J--�-r Installation will serve: Residence ❑ Apartment House Commercial Trailer Court ;[] Motel ❑ Other --------------------------------------- Number of living units:--d Number of bedrooms _- -__--Garbage Grinder ___.O_-_ Lot Size ------Private ElV_Y 1,5_------------------- Water Supply: Public System and name ----------------------------------------------- Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ a - — - Hardpan ❑ Adobe-® Fill Material ______.___ If yes, type ' '61 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] q NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] V F size-_ ,9 f- f ---------------------- liquid Depth . PACKAGE TREATMENT [ ] SEPTIC TANK app L /✓/e757-ST Material_4 tAo C.�L-r2--No. Compartments -rZ----------_•••- capacity f- ------� TYPe F Distance to nearest: Well -----SO-.r-----------------•-Foundation __/ -_ Prop. Line _.,.3��••---.. E [ _ ------- Length-of each line------k?....---.-- -__ Total Length :_----` P_�___..------. LEACHING LINE [�]- No. of Lines '_-------- --- -- , i ------•----------- i, 'D' Box N__0----- Type Filter Material _�OC -----_Depth Filter Material --If-'I Distance to nearest: Well ___ .r-------- -- Foundation __J.0----------------- Property Line --'4^ I SEEPAGE PIT [ Depth __ --------- Diameter --�33_ ---- Number - ------ ------- Rock Filled Yes ] No ----- --/� -L_� Water Table Depth ________ ______ --Rock Size `-------- Distance to nearest: Well ____1_� ------------•---------- Foundation ---1 ----------- Prop. Line _57.'-•.......... REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------------------------------------------- Date ---.-----------------•------------} Septic Tank (Specify Requirements) --------------------------------------- --------- ----------------- Field {Specify Requirements] ------------------------- ---- ------- ------------------------------------------------------- 3 --------- --------------------------------------------- -------- ---- -- - - - - - ------------- ------ - - - --- ---- - - --- (Draw existing and required addition on reverse si e] I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Slate 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, 1 shall not employ any person in such manner as to'beco�a subject tA Workman's Compensation laws of California." Signed ' - --------- Owner Title By --------------------------------------------- --- -- (If other than owner) TMENT USE ONLY DATE 1a-`" APPLICATION ACCEPTED BY --------- - - - - ----------------------------- BUILDING PERMIISSUED --- -- _ -------------=------------ --DATE -------------------------------------------- ----- --------------------------- ----------- - j ----- ---- ADDI AL COMMENTS - ------ --- --- --- - u ------------•------------------------------------- ---- --------- ------- ---. J - --- --------- -- - -- ---- �------- ----- ------------------------------------- ----------------- - --- 'Date ----- f - ---� 6 Final Inspection by: ---- _ _ JOAQUIN LOCAL HEALTH DISTRICT ��""f�"6� �.�Y .1��s��l/ � f- �/��1'k•1�s`t�c�� f��s-i ]`'� ,�r�rr�'�G.//'G��6� E. H. 9 1-'b8 Rev. 5M /