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F9R OFFICE USE: X APPLICATION FOR SANITATION PERMIT Z"-3 3- {Complete in Triplicate) Permit No. ---------=- - ------------------------------------------ --- Date Issued ___�_-��--�L ----------- ---------------------------------------__ 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 .- j_(3-�)_Z�--- :---.-------�� rl CENSUS TRACrT.. os Owner's Name ._.._G .�--------------------- _ � 1C ----------------------- --------------- - --------- ---------Phone Phone - ------�-a-�-- Address -1 � � �T-- - �� --------- . City ------- � ------------------------------------ Contractor's Name --------------- V---------------------------------------------------- --------License # --------- ------ Phone ---------------------- ------- Installation will serve: ResidencegApartment House❑ Commercial ❑Trailer Court [1 Motel ❑Other -------------------------------------------- y Number of living units---- __._.--- Number of bedrooms Z-----Garbage Grinder _ Lot Size -- __ ---_______- Water Supply: Public System;and name --------------------------------------------------------------------------------------------------------------_PrivateX Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay .❑ Peat❑ Sandy Loam -❑ Clay loam i� ' 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.) �I NEW INSTALLATION: lNo septic tank or seepage pit permi i p is sewer is pyailable within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAN K 1z —-V fl_ J_ --------- Liquid Depth _ _(9___ Capacity 2 T e ------ ----------- M ria)- o. Co partments _-- --------•- • -•-•- Distance tc nep est: II _ _ _- Q _ _ ___________Foundation _t -��-_- Prop. Line - �---rJ- ----- LEACHING LEACHING LINE `� No. of Lines ----- ------ ___ _ Len th of ach I' e--_5-�__________ g --- - l-------•----- Total Length `�7-�- �l?� ti D' Box .. Ty.e F ter aterial -_ Filter M�teriai __ _�----------------------- �---- Distance nearest We 501---- Foundation &'i. a------- Property Line( 17--__-_------- w ,` SEEPAGE PIT [ ] Depth ________ _________ Diameter ---------------- Number -- _-___._.____.______-___ Rock Filled Yes ❑ No i❑ Water Table -•--��__;_'�--Rock Size -------------------------------- 1 , Distance to nearest: Well ----------------------------------------Foundat''ion.-____;_°-_---------- Prop. Line ...._______..._--_.1.4 ----------� ------------------ Date .: . REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________ } y SepticTank (Specify Requirements) -------------------------------------•-------------------------------------------------------:------------------ ------------------------ DisposalField (Specify Requirements) ---------------------------------------------------------------------------------------------------------------------------------- F----- ----------- - ---- I---------------------•-- ---------------------------- ---------- = =--------- ---------------------------- ------------------------------------ ------------------------------------------------------ 1 a ({Draw existing and required addition on reverse side) i. I hereby certify that 1 have p epared 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 th ing: "I certify that i" perfor a of the ork for which this permit is issued, I shall not employ any pers6n.,in such manner as to become u ct to r pensation laws of California." Signed - --__ Owner -- . ! Title: �.- BY --------------- --------- --------- --- ----- -_-- - ---- . (If other than owner) ! F9 PjbEP&RTPjENT USj ONLY APPLICATION ACCEPTED; BY` _ - DATE __t �. " , -Z___-- --- ------ --- --- BUILDING PERMIT ISSUED ------- ---------- - ------------------------------------- -- - - -------DATE ---------------------------------------- r ADDITIONAL COMMENTS __________________ -� F ---------- -----------------------------------1 ----------------------------------------------------------------------------------- = ----- e ��, E a d;,+ ---------------------- ------------------------------------- - I r i --------------------------------- ----------------------------------------------------------------------------- ------------------------------ = Final Inspection by: -- ' ---------------' Date ------- ----------------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT _ E. H. 9 1-'6B Rev. 5M