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t FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. t This Permit'Expires'I Year From Date Issued Date Issued 4 Application-it hereby mode to the San-Joaquin-Local Health District -for a permit 10-const.r.uctand install-the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ray - JOB ADDRESS/LOCATION C1------ Owner's Name - - ---- --- ----------------- ----CENSUS TRACT ------- - ---------•----- i � . � f------------------------ -------Phone f� 01- Address --------------- ---- --------- --------------------------------------- - City ------ Contractor's Name a,Y•- _.. Phone Installation will serve: Residence ]'Apartment House❑ Commercial ❑Trailer Court • ` Motel ❑Other---------------------- Number of living units:-._-- -------Number:of bedrooms,,.-/* Garbage �- -- Lot Size Water Supply: Public System and name ---------------"__-- - - PP Y Grinder _--____--- Private Character of soil to a depth of 3 feet: Sand'❑ Siit.❑ Clay ❑ Peat El Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 'A . Fill Material ------ ----_ If yes, type ------------------- - (Ploot plan, showing size of lot, location-of system in„relation._to wells, buildings_, etc. must be placed-on- reverse side.) NEW INSTALLATION: (No septic tarik or seepage pit permitted .if public sewer is available within 200 feet,) .- PACKAGE TREATMENT [ ] SEPTIC.TANK [ Size_---_,----•_ _- _- --------------------------- Liquid Depth -------------------------- � Capacity ��-r { P Y Type Mated al No. Compartments ------- O Distance to nearest: Well _ 1 0�------------ # f - ---------- h Wfounclation -------- ------------- VProp. Line . LEACHING LINE [ No. of Lines _ �� -------____- Length of each line _----- ---------- Total Length - -_--�- T_-YPe Filter Material "efria-1 ---- V -,- _: --bBox .-- :( __Depth Filter e-r 1M---at_erial -----------/i -Distanceto-nearest:-Well ---- Foundation ---- --- Property Line ------- Number ------------------------- Rock Filled Y es � Nof• oSEEPAGE PIT VJ Depth ---- Diameter Water Table Depth ----------414--) l > ------------------ --------Rock Siie �------------------- l ;- , � I /' Distance to nearest: Well --------- -------------- --Foundation ----- ------ Prop. Line -.- ?c - ---EPAIR DDrev. Sanitation Permit# ..----__..- Date TSePtic Tank (Specify Requirements) --------- ----- -------- ------------------------- ------------------------- Disposal Field (Specify Requirements) L ---=----------------- --------------------------------------------------------------------------- ------------------------ - - ----------------------------- - ------ --- D raw -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 ; Couniy 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 tolbecome subject to"Workman's Compensation laws of California." I �- Signed -- ----- B � s J-�----- ,�---- --------------------------------- Owner Y - == __ = cY _ ------------- Title __.-(If other than owner) ------------------------- FOR 2c' J ---------------------- ' FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y ----- -"- - k ------------------------------------------------------ DATE -- BUILDING PERMIT ISSUED- - = = - . -----------� :_:�_= '==-' = - _-._•___. = ADDITIONAL COMMENTS ---------------- DATE ------------- ,-.--;•---- .: --------------------- - --------- -------------------------------------------------- - ---------------------------- --------------------------=---------------------------------------------------------------- _ --------------------------------------------------------"------------- ------------------------------- -------------------------------- Final'Inspection by: ------ - --- ----- ---- -------------Date k �c.-`-- " - -SAN JOAQUIN LOCAL HEALTH DISTRICT E:-H. 9 1 '6$ Rev. 5M - '�.