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FDR OFFICE USE: f ; _ APPLICATION FOR SANITATION PERMIT I ------------ ------------------- - Permit No. (Complete in Triplicate) -4.•+- _—l- _ � Date Issued __-� This Permit Expires 1 Year From bate Issued ___/�7 / --------------_'.__s_-------:""_:_---- ---------------- . u ApPlication is hereby`made to the San Joaquin Local Health District 'for aT permit'to construct and install"the 'work' herein i described, This application is made in compliance with County Of � !,nonce-No. 549 and existing. Rules" and Regulations: i JOB ADDRESS/LOCATION .._.__ __ _ _ --- - --�' _ sJ •Cc��t-C_ CENSUS TRACT __� _ � L- j4 Owner's mName ______ ---- �_--- ------ ----Phone `- ��Is --1- ` -------•--- `, ------------------- Phone 715Z� �Address i -f- City A,� "- Contractor's Name ___--- r ------ -- -------- Installation will serve: Residence) "Apartment House-E] Commercial ❑Trailer Court ;❑ Y Motel ❑ Other --------------------- ---------------------- Number of living units-.._ Number of b Brooms ____Garbage Grinder e$110--- Lot Size Water Supply:.Public System and name _- - -- ----------- --••-------•#----------------------------:-----Private _ _ _ Character of soil to a depth of 3 feet: Sand'❑ Silt f Clay ❑ Peat❑ SandyLoam ❑ Clay,Loam F` F ➢� � Hardpan ❑ Adobe Fill Material ----------_ If yes, type ---------------------------- (Plot _______.__________-_____(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,) i I PACKAGE TREATMENT { ] SEPTIC TANK'' i Size_____ �[�.�'�_�--X_ '��---- ------- Liquid Depth -----��------------- Capacity /eriG__'�Ar4,[Yype /A-g-d4d4aterial---.- J __. No. Compartments --.J------•.------- ----------------------- ------ t Distance to nearest: Well ___ __ _____________:Foundation _____��1___A____ Prop. Line _____' '_�_____T LEACHING LINE No. of Lines f Depth Material __�_ �' - Length of each line = Length - ------- 'D' - - _ _ _ Total J_ - 'D' Box .__�____ Type Filter Material � ----- p �__r---------°___._________._ Distance to nearest: Well _____45"�_r` Foundation __ _- ---------- -Property Line r e ... r -------------- -e Diameter E SEEPAGE PIT NDepth -------- umber -----07------------------ Rock Filled Yes 00 Water Table Depth ____ (J ______ -��_W ----------Rock Size __c.2__` Distance to nearest: Well €__ _____________Foundation Prop. Line ....� ..�__._. f _ r REPAIR/ADDITION(Prev. L# - -------------- _____________ Date _______________________________-_-1 F Septic Tank (Specify Requirements) ------------------------- --------------- ------------------------------------------------------------------------. � r Disposal Field (Specify Requirements) ------:--------------------------- r • �.1.-. :y �.,! f __________ __ _ _ . __..______________________________________________ __________ ____---_______-___----_-__ ________._____________________- __ ___________._____ t (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. Homeowner or licen- sed agents signature Certifies the following: ` ,r "I certify that in the performance of the work for which this peFmit is issued, II shall not employ any person in such manner as to become subject-to-Workman's Compensation laws of California." Signed --- --- ------- ' ) Owner 15;BY ----- -: 'u ._. Title �- ------------ 5-i f other than owner' I J ORD ARYMENT USE ONLY � 1� 7 7� APPLICATION ACCEPTED BY ----� : - ----- -a.d�` --- ------------------ DATE ---- - - - - --------------------- BUILDING � ------ ------- - ------ ------- PERMIT ISSUED = j -------------------------- ------------------------ -------DATE ------------------------------------------ ADDITIONAL COMMENTS -- -- - --------------------------- ---- - --------------- ---------------------------- ------------ ---------------'-------------------------------- _ FinalInspection by: -- ------------ - - -- -- ---- -- - - --�------------------------------------------Date �j/-s-�- ---f- -------------- F ^--�_ 'fir-'-_- - JO U!N LbCAL HEALTH DISTRICT .- SAN .. - •. � _ � ' E. H. 9 1-'6$ Rev. 5M _