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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Y- { -�- ...i�-'._.,_.:.:'-, --- - Permit No. --•.. ..-...�:_�.� y (Complete in Triplicate) r Date Issued This Permit Expires 1 Year From 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 J County Ordinance No. 549 and existing Rules and Regulations. f 7 /" `� Lr� --- ......-CENSUS TRACT JOB ADDRESS/LOCATION' .------------ _ Owner's Name--e- ------------------------- - Ph j: one �J - Eco ------•--- Address -... 7.9� ':. �7`lC - ---- � �.- U City �� ;. License # ...._.. 3 .yPhone Contractor's Name ...__ c.t .. `a - Residenc ] Apartment House-0 Commercial []Trailer Court Cl Installation will serve.• ❑ , lJhc-+.1__..L' 1---------•--- Mote! F1 Other __,_..___....-_...-. Number of living units r=--- Number of bedrooms :_-...Garbage Grinder -__—__.... Lot Size ...... ------------------ --------- -------- Water Supply: Public System and name - ---------------- ------- Private [� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Ff_-Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan D 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,) PACKAGE TREATMENT [ I SEPTIC TANK{ ] Size----------------------------------------------- Liquid - Depth - ----- ------------------- Capacity -------- ------ Ca acitY -��--------- --- Type -------------------- Material------- ------ -��- No. Compartments ---------------------- Distance ------------••--Distance to nearest: Well ------------------------------------foundation .-----.--------------- Prop. Line -------------------•-- LEACHING LINE [ ] No. of Lines ----------------------- Length of each line--.--------------------- --- Total Length --------.----..------------- 'D' Box - ----- Type Filter Material _------------------Depth Filter Material .-----..........--.-•.--.--•-----------•---- r Distance to nearest: Well ------------------------ Foundation . Property Line ..--_-------------_.__.. ------. Rock Filled Yes No SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------.--------- - ❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest. Well ---------------------- Foundation - ------ Prop. Line ..--..._-._._..-_--- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- ------ Date ----------------------------------1 Septic Tank (Specify Requirements} --------------------- A' ---- ------- - ----- Disposal Field (Specify Requirements) -----------L--r�r- =........ 6- --X-- ----1--- --- - ` iS ------ -- (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. (tome owner or_licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shalt not employ any person in such manner as o a to becub'ect to Workman's Compensation laws of California." Sighed .. .. Owner �� Il "4: r • `"E-[.. - -- ------- Title . ..:..... . . ..'�-��"[{'------- (if - --(If other than own r) 't FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-.-.. - -------------- DATE . ..... -------- BUILDINGPERMIT ISSUED ------------------------ ----------------------------------------------------- --------- ---- -DATE ADDITIONAL COMMENTS i ------- ---- ----------------------- ---------------- -------------- i Final Inspection by: .-- Date - r� ---- ---- - I I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M