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FOR OFFICE USE: ------- - a�(0 0 ----- ----------------------------- ------ APPLICATION FOR SANITATION PERMIT Permit(Complete in Triplicate) 'r ------------------= ----------=------------------------ Q Date Issued • -----------------------------------------.--------------- 3 '00 This Permit Expires 1 Year From Date Issued Application is hereby made toSan Joaquin Local Hea1t17 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: Af .- _ __ JOB ADDRESS/LOCATION ��.�!.�� ,��tS'_----------------------------------- � CENSUS TRACT ____ ________ ___________ Owner's Name A 4��6- Phone�27p"-•�/J4----- Address - 2,2-a-��------ � � �� 11C } s!- Jp ._-_.... City I-7 11Std------- Contractor's Name ''-—.....:.........License i4��- ®__ Phone 49J!$ � Installation will serve: Residence ❑Apartment House,❑ Commercial ❑Trailer Court ❑ s ' Motel ❑Other :: AA Number of living units:.._----- Number of bedrooms Garbage Grinder-44VLot SizeQ --------------------s............. Water Supply: Public System and name ----------------- Private _ Character of soil to a depth of 3 feet: Sand' Silt El Clay ❑:.e Peat❑ Sandy Loam E] Clay Loam;❑ . Hardpan ❑ Adobe ❑ Fill Material .-_.._ ---- if yes,type ___________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seeps a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK [ Size_?-- -.4�-- a- --- Liquid Depth ------------------ Capacity Apr Typehkk__ Materialt eA—ICZ�� No. Compartments �..........01 ..... Distance to n arest: Well --14049---- Foundation 044714-t-- Prop. Linear�._0.i._-•._ LEACHING LINE No. of Lines --- -------- Length of each line__ [� �----- 9 ��----------- --- Tota! Length�,�------------------- �ID �q ' i 'D' Box . ..-- __ Type Filter Material Depth Filter Material ---------` -�................. .......... oe ` Distance to nearest: Well __ � ------._.._ Foundation ?0-------------- Property Line .._._._.___.._. SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No .13 WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -----------.---------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ---------------------------------_} SepticTank (Specify Requirements) ------------------------------------------------------------------------------- ---------------------------------------------------- Disposal ---:---------------------------------------------- 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: r "I certify that in the performance of the work for which this permit is issued, I shall not employ any person. in such manner d as to become subject to Workman's Compensation laws of California." ? Signe ------------ ------------------ Owner ' 1 BY ----- ---- ------- Title -------- 1' A/J®--------------- (If other than o - -} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- l ©----------------------------------------------------- _ DATE ------ ------ BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------ =-------------DATE ------------------------------------------- ; ADDITIONAL COMMENTS ------------------------------- ---------------------- ------ - ----------- -------------------- -------- ------------------ ------ -------------------------------------- -------------------------------------- - ------------------- -- �- -_ Final lnspec �ii� � /.1 Date l- - ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M