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• FOR OFFICE USE: , APPLICATION GR SANITATION PERMIT (Complete in Triplicate) Permit No, _ _. _______________ This Permit Expires 1 Year From Date Issued 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 . 9_p 0 Wil-._SmC/o e�s,_/� ' ------------ --- --------CENSUS TRACT =:: - = Owner's Name �' X11 L_,�----------------------------------- --- ---------------------Phone -�o -----9-7-3-1--- 1 ' / r Q Address a °--9-Q-a---�- --'-- - co/ _�__ City /j eG fUC� ----- -------------- Contractor's Name -5.e— d a)_Ne-------------------------------- -- -----License # ---- -------------------- Phone ------------- Installation will serve: Residence.1 Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑ Other Number of living units:----I------ Number of bedrooms _-_3------Garbage Grinder ------------ Lot Size --------- ------------------- --------------- Water Supply: Public System and name _- ___►-- 'VO-n ------------------- ------------------ -------------------Private ❑ Character of sotl to a depth of 3 feet: Sand'❑ Silt❑ Clay E❑ Peat❑ Sandy Loam (? ( Clay Loam.❑ _----- ------------------------- Hardpan E] Adobe [:] Fil! Material_--U�LIf 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 seepage pit permitted if public sewer is available within 200 feet,) �r PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] i Size------------------------------------------------ Liquid Depth ----------------_--------- Capacity I oo Gq.I Type �/ -- 4 __ ___________ Materia Q;rac1-�1'`e_No. Compartments _-_ ______._......._- � Distance to nearest: Well __ -_ s_Pf---------------Foundation ------------------------ Prop. Line _--___________-_----_ LEACHING LINE ' [ ] No. of Lines- - ___________________ Length of each line- ---------------- Total Length _�__y_d_._...._______ - k , 'D' Box --__ ------- Type Filter Materially ck/'-49"--Depth Filter Material ---1.4-ird_ _______________ Distance to nearest: Well __�_7�- ______ Foundation ________ Property Line -_5307.--_-_-_____ SEEPAGE PIT [ ) Depth ________________ Diameter _-_---______-__ Number ---------------------------- Rock Filled Yes C] No f Water Table Depth�---------------- ---------------------- --------Rock Size ---------------------------- Distan ce to.nearest:'Well ________________________________________Foundation -------------------- Prop. Line _______....-__._._____ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic ------------------------- -----Septic Tank (Specify Requirements) --:---------------------------------------- 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: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject o Wo r an's Co p nsation laws of California." Signed _ �,�.i s f�-'�-- --1--- Owner By --------------------------------- ------- ---------------------- Title .. f (If other than owner) -------------------------------------------- FOR DEPARTM-ENT USE ONLY APPLICATION ACCEPTED BY DATE ---� �-- - ,�-- ---------_ BUILDING PERMIT ISSUED ------------------- DATE NAL _--- ADDITIO COMMENTS-------------------------------------------------------------------------------------- ------ ------------------------------------------------------------------------------------- - - - - ----------------------------------- -f ------------- ----------------------------------- ------------------ ------------------------------ T --------- ------------------ = ---- -- Final Inspection by: -=- (/ --- ` _Date -- --------------------------------------- SAN JOAQUIN LOCAL HEALTH,DISTRICT ' E. H. 9 1-'b$ Rev. 5M