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E FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------- ---------- n, Pe _ -1 � )Complete in Triplicate) rmit 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 r described. This application is ma/de in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -__ ! X3 ___ y' �-_ TRACT s � �_— w! Phone Owner's Name '-� �(� "` 96 Address . - =-i--- - ------------------------------------ City s ----------------------------------------•-- Contractor's Name ---------------i-----_-- -- ------ -------------.License # _ UU / - -- Phone --- --'t— Installation will serve: ResidenceApartment House,❑,Commercial:❑Trailei Court ',❑ Mote []Other --------- -^.i -V j X61; Number of living units:------------ Number of bedrooms ---`71'Garbc ge Grinder __- .__-__._ Lot Size _______ _ fZ Q. ----- Water Supply: Public System and name - -.4.-------------- --- ------ -- ---- I -----------------Private ❑ F Character of soil to a depth of 3 feet: Sand'❑ Silt E] y ClaPeat❑ Sandy Loam E] Clay Loam.F] Hardpan E] Adobe�( Fill`Nlaterial _ If yes, type _k___ ______________________ 1 (Plot plan, showing size of lot, location of ss stem in relation .to wells, buildings,.etc._must be placed on reverse side.) NEW INSTALLATION: (No septic tarik br seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ ] SEPTIC TANK [F] ` Size-____-- - -;`_ --•----------------------_---- Liquid Depth ------------------ Capacity --- ------------ Type -------------------- Material---------------------- No. Compartments ------ ------ ......... Distance to neares-)Nell—7-4-------------------------l Foundation --------------- ------ Prop. Line ---.---.-- •.:----.--- J� LEACHING LINE [ j No. of Lines ------------------=-- - LIbngth-of-each--I Total Length ----------- ---------------- v. 'D' Box ------------ Type Fil�r,Material -_____________ _hDepth Filter Material -------------------- ------------------ I f w Distance to nearest WeII1`��-^-__-_ Foundation-------------------------- Property Line i SEEPAGE PIT [ ] Depth ----------- ------- Diameter _ ______________ Number ------------ --------------- Rock Filled Yes '❑ No C] Water Table Depth - -------- ------- ---------------------------Rock Size------------------ ------------ Distance to nearest: Well f , ---- ---------------••--- --,--Foundation --------------- ---- Prop. Line ---------•------_-•••- REPAIR/ADDITION(Prev. Sanitation Permit# - _ __ Date ________ _____________ _ ------------- --- -- ._} Septic Tank (Specify Requirements) --------- -------- -------- Disposal`Field (Specify Requirement ___.__ .�---1E------_-._---- ---_ - ��t �r r p� �` ---� f�- l --------------------- -- - -- (Draw existing and required addition on reverse side) 1 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 to Workman's Compensation laws of`Californid O'k �J '� , Signed ---------- ---------- ---------- ---- ----- -- ------------------------------ Owner BY ---------- --- - --------- -------------- Title - ----- ---f- ---------------- --------- ---------------- (if other t owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ------------------------------ -------------- ----- ----- - - -----------------------------------------------------. DATE ---�-r- t 2 5------------------- BUILDING PERMIT ISSUED ----------- f �e f D ADDITIONAL COMMENTS . " '-!-----�' 4 . [� .-- - - - ---------- -------------------- --------------------------------- ---�-------- --- ------------------------ � -------------------------------------------------------- Final Inspection b ---------------------------------------------------------------Date ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M.