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FOR OFFICE USE: -1 a,dw-0�----- z /`.0- '------------- APPLICATION FOR SANITATION PERMIT Permit No:--`�'-��--"-°---�� (Complete in Triplicate) Date IssuedThis Permit Expires 1 Year From Date Issued e work rein Application is hereby made to the San Joaquin Local ifihealth CounDistrict for a per "ty Ordinance No. 549 and existing Rulesmit to construct and talndhRegulations: This application is made in compliance w Y described. Y✓ _s }� /F] ��lQ/�C,-�-_CENSUS TRACT L_ Q JOB ADDRESS/LOCATION _ j�/ -- -- �---- �.2 07J r j/ Ct Phone Owner's Name sr----tx—lww —s---- f�cht------- 1 - h----------------------------- -------- -- i Address_,' �' License ---------------------------------------------------- city �-----#��/7�----- Phone Contractor's Name _ �f'r---T-�- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑Trailer Court 1] - Motel Other ------�at�7 `--------------• II Number of living units: ---./-./ Number of bedrooms --- /----- Garbage Grinder ----___ -- Lot Size ------------------- -- t --------------------------- Private (� Water Supply: y ---------------------------------- 4 Public System and name --_ _""-- -----------•--•- " " Character of soil to a depth of 3 feet- Sand '❑ Silt ❑ Clay ❑ Peat'< Sandy Loam El Clay Loam El Hardpan ❑ Adobe E] Fill Material ------------ If Yes, type ---------------------------- [ (Piot plan, showing size of lot, location of system inlrelation 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,) �A PACKAGE TREATMENT SE -PIC TANK Size"�q ------------------ Liquid Depth ---- K --------- --.----- •�'��' y`- `"'later al ��. -__-----••- Capacity /Rao--- --- Type LNo. Compartments Ofa ' r / Distance to nearest: Well -------¢--- Foundation -�- Prop. Line ._"�-••--�- r Length of each line-- Total Length ID--? 107 ---------- LEACHING LINE No. of Lines --_- """ """ 'D' Box ------ --- Type Filter Material .5, 'e_�C&-Depth Filter Material -----/--------• - Foundation /G -- ------ 1v Property Line. ---_--------•------ Distance to nearest: Well ��------------- (- SEEPAGE PIT { ] Depth -------------------- Diameter --- Number ---------------------------- Rock Filled Yes [] No i❑ Water Table Depth------ -------------------------------- --- -Rock Size -------------------------------- - Distance to nearest: Well ---------------------------------------- ---------------------Foundation - - - - - - - - - - - - - - - - -- -- Prop. Line -------•-------------- REPAIR/ADD1TlON {Prev. Sanitation Permit # -------------------------------------------- Date ----------------•------•----------) Septic Tank (Specify Requirements) ----------------------------------------- --- ----------------- /6 0 Disposal Field -(Specify Requirements) _"-" ----•----- ---------------- �6-- � - Iff -------- ---- -- -- -------------- {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 beco a subject to Workman's Compensation laws of California." Signed ,�----------- Owner -----��-�-�/ ��--------�–�_ f 1�.�--- -- ___ ld�f"��'��-�----------------------- -Title -------- ------- -------------------- - ------------------ By -------------- -- (lf other tfran owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-�/-----------------------------------------------DATE ---�----�--------------------- --- --- ------- ------------ - ---------- -------DATE ------------------------------------------- BUILDING ------------------ -----------------•--- BUILDING PERMIT ISSUED ----- ------ - --- ----- ----- ADDITIONAL COMMENTS --------------------------------------------------------------------------------------------------------------------------------- ADDITIONAL -------------- -------------- ------ --- - - --------------------------------------- ----------------- ------------ - - - - -------------i ----------------------------------------------------------------------------------------------- - ----- --.Date -------. Final Inspection b p Y - SAN JIN LOCAL HEALTH DISTRICT 1 E. H. 9 1-'68 Rev. 5M