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FOR OFFICE USE: APPLICATION FOR SANITATION PERMITPermit No. /J/ 9 Y4 p plicate] ''�. {Cam __.!/41fete in Tri ..---------------------------------------_--------------- This Permit Expires 1 Year From date Issued Date Issued _J >� 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/LOCATI N --7,11_;._5__-. ---�lrfJ_-� �---I��--------- - -- --CENSUS TRACT ------------ ------------- E - ---------- k Owner's Name j �"^' Cit------------ --------- Phone ------------------------------------ ---- -- ------------- -- - Address i ---- ,_ _ Y Contractor's Name -- - --��*-_�-s__'_-__.License #Il '. 7�--- Phone ------------------- ---------- Installation will serve. Resi nce �] Apartment House-F-1 Commercial ❑Trailer Court :❑ Motel ❑Other ------------- ---------------------------- Number of living units:------�__,_ Number of bedrooms _-�------Garbage Grinder ____- ------ Lot Size .44 ------------ I r Private Water Supply: Public System and name --------- ----------- --------------------------------------------------- Character of soil to a depth of•3 feet: Sand'❑ Silt❑ Clay L] Peat❑ Sandy Loam 2� Clay Loam 'L] 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer-is available_within 200 feet,) ( � L ] ------------------ ,+- ----------------------- Liquid Depth --------------------------L lik ~ PACKAGE TREATMENT SEPTIC TANK' Size__._ Capacity r ----- P Y - ----- Type ---- ------ --- Material`---------------------- No. Compartments -----------• �.. ., t w Distance to nearest: Well ---------------------------------t�__Foundation ____------------------- Prop. Line ----------------•---.- [�1 LEACHING LINE L I No, of .Lines ------- ----- --- Length of each line-------------------------- Total Length ----------------------------- 'D' _-_--__--_-_---_--_-----___'D' Box J-------:_ Type Filter-Material --=------ -- -------Depth Filter Materiai- ------------------_--.-----------.---------- Distance to nearest: Well ________________________ Foundation ________________________ Property Line -----._--_----_--- SEEPAGE PIF L l Depth ____I_______________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No C]Water Table Depth --------------------------------------I---------Rock Size ---------- --------------------- Distance to nearest: Well --_-.--.- ----------------------------- -----=-------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ---------------------'--------------------------- ------------------------------------------.-------------------I--- -------------------•--- �'� Disposal Field (Specify Requirements) ..________.lie_______ __ - ._ 1 +_{., r� P7 � � L.u ' '.'e-------------- ----------------------------------------i------------------------------------------------- ----------------------------------------- (Draw existing and required addition on reverse side) I 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 Son 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 became subject to WoLmon's Compensation laws of California." Signed ----- ------------ Owner BY --------------- --------- ---- ------ Title -- -------- (If other than owner)! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY , ---'- -_-------------- ----------------------------------------------------------_---. DATE --716___'7_.. - ------------------ BUILDING PERMIT ISSUED ---------- 1------------------------------------------------------------ -----------DATE ------------- ---------- ADDITIONALCOMMENTS - -- ------(----------------------------------------------------------------------- --------------------------------- -------------------------------------- ----------- i t ------------------------------------------------------------------- - _ _ - --------- ------------ ----------- - ; -- i e Final Inspection by: --- ---'= ----- ( Date r ( ---------------------- SAN JOAQUIN LOCAL,HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M