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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -----------" (Complete in Triplicate) _ i --------------------- Date Issued This Permit Expires l Year From Date issue - 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: ` M:A1117/aGt¢---CENSUS TRACT ----- 6-------------- JOB ADDRESS/LOCATION _--`�---- - ------Phone ------------------- - Owner's Name " ' '---v�_ -- - kIl --ER �� - . �* Address --- --- ?-- J a 19Vim,- Cit Y a`}S�ri'�a Phone h Contractor's Name _ 'Q' l4-----r �' License # ---------: - Installation will serve: Residence ❑Apartment House[] Commercial ❑Trailer Court ;[] Mote! Other --.-DO?44;-X---------•-------- hh � Lot Size _ �- F}�� ---."----------- Number of living units--j------ Number of bedrooms ---I__ __Garbage Grinder - --------------- Y Number """ Private ell -- ----------------------------------------------------------------- Wafter Supply: Public System and name --------------------- ------- - - Clay.Loam:❑ Peat Sandy Loam ❑ Y CRa�acter of soil to a depth of 3 feet: Sand' Silt❑ clay ❑ � ---------------------------- Fill -----" --"--" --.---- _" Hardpan ❑ Adobe'❑ Fil! Materia! _ ___- __-- if Yes,type --- Ian showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (Plat p g � P seepa a pit permitted if public sewer ' available within 200 feet,] _ NEW INSTALLATION: {No septic tank or g . / -- Size__ -�-1--- - -- ------- Liquid Depth -----�"{�--•----- SEPTIC TANK ""------- PACKAGE TREATMENT [ ] t��l y Capacity �, ---- Type - jER. l4- _ Material-___--_---lJ--.1C No. Compartments i Distance to nearest: Well _____-6f�"-------------------- Foundation Jr)-------------- Prop. Line -----S-----•-: LEACHING LINE [�Y' No. of Lines ---�------------------- Length of each line-------�-��------------ To#al Length r�_�Q�-----•------•- 'D' Box�_�- ----- Type Filter Material ��'-��---- -Depth Filter Material -"__--_-1 __--"--•------ )i a Foundation ---/10------ Property Line. ----- ---------------- Distance to nearest. Well -_- ------------- i Depth Diameter --------. Number -------------------- Rock Filled Yes ❑ No I❑ SEEPAGE PIT [ ] P ---------------- -- - ---- Water Table Depth -------------Rock Size _____------------------- ----------------- `: = Pro Line ------- Distance to nearest: Well __�__�'----------------------------- -Foundation ---------------- P fd REPAIR/ADDITION(Prev. Sanitation Permit Date ----------------------------------) } ents) _,-. :-__. _�_,: �s ------------ =------------------------------ Septic Tank [Specify Requirem Disposal Field (Specify Requirement's) -� -^ ------------------------- ------ -- -/ S"—i11 --------CA-J-14-14 ----- v t- -�-�-r-------�� -- `�1'--- - - �- - - . m - - ---------------------------------------- -ON ----------��, � 3��: S � - `�(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 e County Ordinances, state,Laws, and Rules and Regulaatibn#of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: / P arson in such mariner"I certify that in the performance of the work for which,this permit Wissued, I shall not employ any P OF as to become subject to Workman's Compensation laws,of"California." --------/Owne ` Signed _ ------ - ---""""-- g ------ Title - �L ------ ----- -----�P - ------------ BY ----" �""- (If other than o er) _. FOR DEPARTMENT USE LY DATE �2-"_6 ------------ APPLICATION ACCEPTER BY �_ ------------------- __-�-__-.-- --y- -- BUILDING PERMIT ISSUED ---------------------------------------------------------- -------------- ------ -------- ------- --- --DATE ------- ----------- ------- ------- ------ ADDITIONAL'COMMENTS ------------------------ -------------------------------------------------------------------------- --------------------- ---------------- --- - -- -- ------- ----- % ff------- ------ ----- -:------ ---- _ _ _-- ----------------------- Date _J Final lnspe SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M _._