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FOR OFFICE USE: ,I � APPLICATION FOR SANITATION PERMIT ��` Permit No. _-H-740------. (Complete in Triplicate) This Permit Expires ] Year From bate Issued Date issued S'1_ ___ L.___ _ _ . ------------------- -------------_--------------- - 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: F JOB ADDRESS/LOCATI N ----------- 17 Lf�� '�[1 } CENSUS TRACT -------------------------- , Owner's Name -- y_ ` _ ' ff/��'' ---------------------- Phone Address -------- l iter ------------------= Cit._24- Contractor's /� Contractor s Name _--- ------.P.lf�"._��''�--�?��ir�------------------------------------License #1440/0�"�� Phone - -- �----- Installation will serve: Residence)6 Apartment House❑ Commercial ❑Trailer Court ',❑ / Motel F-1Other --- -------------------------------- ------- ) Number of living units. _.L-_-_ Number of bedrooms 9 Garbage Grinder/_VP.. Lot Size -1aAeO--------------------- Water - ------------- f Water Supply: Public System and name -----------------------------------------------------------------------•---------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat❑ Sandy Loam X. Clay Loam ❑ Y 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.) 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) � s •— I /f PACKAGE TREATMENT [ SEPTIC TANK! Size__1�� 1 ----------_-----------_ Liquid Depth ---__---__________ Capacity/��_A__ TypelM�4e�Y_- Matericil.-(!.04V--____ No. Compartments __�--____•---__-- Distance to' nearest: Well __a --------------------Foundation._ -�_____-_ Prop. Line /ate_______._.... 0 LEACHING LINE �jQ No. of Lines ----1-- ___---------___ Length of each line/f.e._______-__-.-_ Total Length e,4,PV_-_________.._ 'D' Box�__�-�-_ Type Filter MateriaV E- _Depth Filter Material j _________________________f....__-_ Distance to nearest: Well r �___________ Foundation ! /----------- Property Line -�` ?.............. SEEPAGE PIT ] Depth .________ Diameter,2 -------- Number ---- ------- ------ Rock Filled YesX No Water Table Depth �zzV------------------------------------Rock Size/--- `------- r f r Distance to nearest: Well _-! G _�------------------Foundation` s --- Prop. Line ___J---------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic Tank (Specify Requirements) -------- --------------------------------------------------------" DisposalField (Specify Requirements) -------------------•-------------------------------------------------------------------------------------------------•------------ F _____________________________.__.___________------___________.____ ---------------------------------------- __________----__________..___ _-__________________-_------______ _ _____-________-__-_-_ '(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. Homeowner 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 California." Signed ---------------------- ---- -------------- --- ------------ --- - ---- -----------------------------• Owner By ----------------------------- - -1/� ------------- -- r - -- ---- Title ----- 1 � ----------------- ----------------- - --------- - - (If of t an owner) f=OR DEPARTMENT USE ONLY : APPLICATION ACCEPTED BY -- - --------------------------- ------------------------- --------- DATE ------------ -- BUILDING PERMIT ISSUED -------------------- ----------------------------------------- ------------------------------------ -----DATE ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------- ---------------------------------------------------- ------- --------------I-------------------------------------------------------------------------------------------------------------------------------I---------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------=-.:-------------------------------------------- --- -- ------ ---------- -------------------------------------------------------------------------------------------------------------- - -- -------- Final Inspection by: . Date ,- L171_l/ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M