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E' FOR OFFICE USE: APPLICATION"FOR `SANITATION PERMIT fDA T Y` i Permit,No:�d-----�. ('Complete in Triplicate) .� ` ----------------- ___________ This Permit Expires 1 Yeitr.'1From'bate Issued Date Issued __ Application is hereby made to the San Joaquin Local Health District for acdhstr to ermit p uct and install the work herein described. This application is made n compliance with�Cguntq Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --------------- - ------- -- -, ,. - ----------CENSUS TRACT ------T6------------- _. . y .�...,_ .. _ Owner's Name f �Z-- `� --------- -�-y------- ----�---------- ---- Phone ------------------------------------ -------Address ------- ---- - -------- l!/ w�! rv. City ��------- Contractor's Name .---- -_.-- 1Q- - ------------------------------------License # Phone Installation will serve: Residence ❑Apartment o se'❑-Cd-rVmercial ❑Trailer Court"q;❑ Motel ❑ Other ------ , Y.4_- -- --_----- ` Number of living units:-- _ _ Number of bedrooms - - -ip� • g �- ----- :__Garbage Grinder _ __._ Lot Size f__4 - - Water Supply: Public System and name ------------------------ f -------------------- ------------------------------- -------------------- Private �,,Character of soil to a depth of 3 feet: Sand'o Silt❑ Clay .❑ Peat❑ Sandy Loam ,n Clay Loom NJ N F Hardpan ❑ Adobe ❑ Fill Materia/vo_. If yes, type____________________________ � r1 W (PI'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side`), 0 . NEW INSTALLATION: (No septic tank or seepage pit permitted-if public seweir'iis available rXdthin 200 feetf W PACKAGE TREATMENT ( � SEPTIC TANK+[ Si - ---,�[ --- � .-- .Liquid Depth /-_ -------_- �► i Capacity ------------------ Type - - iateria_ 0�1 o. Compartments Distance to nearest: Wel! ----------Foundation --__ ---C_-__ Prop. Line -- � LEACHING LINE XNo. of Lines .�_ f 1 __ Length02ea fine. _r_____________ Total Length ---^___.___- D' $ox ___ Type 1 filter M q� _ ______-_Depth Filter Material ---------.__------ Distance to,+ nearest: Well ___________�_ _ Foundation --_-______ Property Line ___________rDepth _ _-- -- -- - Ro, Filled Xes No d -- Diameter _ Number ____ ______. Water Table Depth --------/�- �' ] f� �/ --------- ------------------Rock Size _f- Distance to nearest: Well _.__ ________________Foundation �(�_�_____ Pro Line ___-�_�__....__.. p. ,.. REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------+------------------ Date --------'-------------------------) . Septic Tank (Specify Requirements) --------------------------------------- ---------------------------------- ------ r Z bisposal Field (Specify Requirements) ------------------------------A------ ---------------Y---------- --------------------------------------- ----------------------------- `--- ---- ------ 1 `-� p ------------------------------------------------------------- -'------------------------------------ --------------------------'------ ------- _____ --- --- ------ - - - ----------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 hereby certify that 1 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 per'Formance 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 California." Signed ----------------------1"Owner + ___________ ___ i BY -} Title F-f --------------------------- - ---- ---------- If er han owner! t DEPARTMENT USE ONLY APPLICATION ACCEPTED .BY _ ----- -- DATE ------ --- / "/ ----------- I BUILDING PERMIT ISSUEb----------- - ----- ------ --------------------------------------- ' DATE ----------------- -- i ----------- ADDITIONAL COMMENTS,' ------- -------------i---- ------------------------------------- -------------- ------------------------------------------------ ------- ------------------------------------------- -------------------------------------- ---------------------------------------" ------------------------------------------ - - - - --- -- -------------- ------------------ --------------------- --- --------------------------------------------------------------------- ----- --------- = rte J e . - -------- ------------------ -------------------------------------- t--- -- - --------- ---- _ Ina ns _ ------ ----------- V �p� Dateg//�- -------------- SAN OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b$ ev. 5N1'• `