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FOR OFFICE''USE: APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------------- a- (Complete in Triplicate) ------------ --------------------- Date Issued -------------_-.--� - This Permit Expires ] Year From Date Issued E i Application is hereby made to the ;an 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: v, ii �j JOB ADDRESS/LOCAT ---3116-.i_-----E-------/� SS J__ i ------------------- ---------------CENSUS TRACT -- - 7--•--- 1 _yN __� _ = -------------------Phone --------------------------=•-------- Owner's Name. _.___T_ d' "� ( ------.5------- Q 1 ` ; �' �. City -----� �� ----------------- -- Address ---- - - ------------•-- Contractor's Name -------0UJI-E = -----`.License # ----------------- Phone ------------------------------ ------------------------------- ----------- Installation will serve: Residence ❑Apartment House,Q Commercial ❑Trailer74Court ;❑ Motel ❑ Other -------------------------------------------- Number ------------------------------- -- --Number of living units------I----- Number of bedrooms Zn�--Garbage Grinde Lot Size ----/ ----------- Water Supply: Public System and name ---------- -----------•- ---------------------------------------------------------------------------•---------Private Character of soil to a depth of 3 feet: Sand'E I Silt Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam -- _ Hardpan. - Adobe'❑ Fill Matetia�_= :_-- -- 1f yes, pe ------------------------ {Plot plan, showing size of lot, location of stem` in relation to wells, buildi s, etc must be placed on reverse side.l NEW INSTALLATION: (No septic tank or se( page pit permitted if public sewei is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK![ ] Size--------------------------- ---------------------Liquid Depth ---'----------------,-.--- CappcitY�------- --- ------- Type ''=' Material No. Compartments ------------- v " Distance to nearest ell -------z_-------------------------Found tion ---------------_--.--- Prop. Line --------•------------- LEACHING ----•--- 1 LEACHINGLIN> {]i No. of Lines Length of each '-line.---__--- ---------------- Total—bength .-______--_.---__--------- + } 'D' Box ------------ Type ilter Material --------------------Depth filter.-M_aterial•_�-----------------------------------•------- t� Distance to nearest: II ------------------------ Foundation ;-:_' - :----r --- !Property Line ----_-------------._.._. S P,AG/^¢tE PIT L ) Depth -------------------- D ameter ---------------- Number --------- ------------------ Rock Filled Yes ❑ No i❑ + t Water Table Depth __,-- _._ _Rock 5 �. z �t.,) ------ - Distance to nearest: Found i n -------------------- Prop. Line -------- ------------ REPAIR/ADDITION(Prev. Sanitation Permit# --- - -------------------------------- - Date ------ ----_--_--_------..-------} t Septic Tank (Specify Requirements) ------------- - --- ------ ------------------------------ --------------------------------------•---------,------------- ---------- Disposal Field Field (Specify Requirements) _/ ------ --------- -------0-------- --------- - LI_n -�=-----------/-------------- ` X ? . :.'.. = -=------------ .—--------- -- - - ----- ------- Pl_�-�----------- - .� (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 si ature certifies the following: ; "I cern h in the perfor nce of the work for which this permit is issued, I shall not employ any person in such manner as to b e subject to man's Compensation-laws of California." 4 Signed ------'=--------- "- Owner -- - - - ---- --- ----- -- -- ------ ------------ By ------------- -----------------f''------ --------------------------� �---------- Title --------- -------- ----- -------- -------- ------------------------ (If other than owner) FOR_=DEPARTMENT USE ONLY p } / L .: APPLICATION ACCEPTED BY .. 'fi'i --------------- I-------------- --------------. DATE 1 BUILDING PERMIT ISSUED --------------------------- -------------- ---------- - - -------DATE ------- ----------------------------------- - ADDITIONALCOMMENTS ---------- -------- -- -------------------------------------------------------------------------------------------------------=--------------------------- s - - - -- -------------- ------------------------ - ----- ---------- .- _��. __ ._... ..� �. - — - ----------------- ------- - - - ----- -- -- - - - - - - - ------ ---- '-sem y ` Final inspi ---- Date -----.� -- -- r ` SAN JOAQUIN LOCAL HEALTH DISTRICT , k E. H. 9 1-'68 Rev. 5M.'