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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: (Complete in Triplicate) ---.------ This Permit Expires t Year From Date Issued Date Issued ___ - �-_.Z. z, 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 incompliance with County Ordinance No. 549 and existing Rules and Regulations: ' JOB ADDRESS/LOCATION ---------------=- ------CENSUS TRACT ---•---------------------- Owner's Name .--_ 0- --.-- ---W-�.-h f 5 Phone �'' � ; C£ Address ...... -�-- ----------•------------•----•------------------------------- City -`h------------------------------------------------ Contractor's ------ # . cs ---- Phonev? Installation will serve: Residence EN Apartment House❑ Commercial:❑Trailer Court i❑ Motel ❑Other ------------------------------•---•--------- Number of living units-------L. Number of bedrooms _.._-I---.Garbage Grinder __ ____ Lot Size _____`452 ....... Water Supply: Public System and name ------ ---•-----------------------------------------------------------------------------•----------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam El Clay Loam ❑ Hardpan ❑ Adobe-OK 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 { ] SEPTIC TANK; ] Size-----•------------------------------------------ Liquid Depth ----------------•----.-•_-• Capacity --------------------- Type -------------------- Material---------------------- No. Compartments •-----•----------=---- _ Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. line .-..--•.------------.- LEACHING LINE 00 No. of Lines --------/-------------- Length of each line........ ............. Total Length ---fie_........ .._.__ ( 'D' Box .___ Type Filter Material _____.. .. Filter Material --------1_ --- _____________________ } Distance.to nearest: Well ------ F.oundation ----`-- Property-Line. ............. -. i SEEPAGE PIT Depth _____ -�.�__-_. Diameter .._- Number _____________ _____________ Rock Filled Yes R No 0 i � __ _ Water Table Depth ----------------- -----------------------Rock Size.---A..------------------- Distance to nearest: Well !;2.... ...........Foundation ------ Prop. Line .-- _. REPAI ITION ev. Sanitation Permit# -------------------------------------------- Date --------------------.--_-----.----1 i Septic Tan (Specify Requirements) ----------•----------------------------=-------------------•--h- ----------' -.;._.......- --------•---•--.,y�--... - I � Disposal Field (Specify Requirements) _______________ ____f , .------ -- - ----- --- ------ -c@s -e - -- / ------------------------------------------------ - ----------------------•------ 4 --------------------•--w------------------------ i • ` ------------- ---------------•------------------- --•------------------ --------------------------------------•-------------------•-•----------------------------------------------------- (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 LocalgHealth 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 I J as to become subject to Workman's Compen3atian laws of California." ,- Signed -------- -------------------- -- --- --------------------------------------------------. Owner 1 J -- ------------------ BY •--•-- �- '•--------- - - -- ----- •-------- -------------------- title _ - - � -- -- --------- � (If other than owner) a FOR DEPARTMENT USE ONLY i a APPLICATION ACCEPTED BY - ------------------------------------------ -------------------------------------. DATE ----� L-4---------------- BUILDING PERMIT ISSUED -- --- -----------•-- - ------• --- -------- DATE ADDITIONAL COMME '�-- ------- - ------------------ --------------------- -------- r ` -- -------------- --- --•---- --------------------------------- - --------------------------------=------ -- -------- - - - --------7--- ----------------._---- ---------------Dates Final Inspection b � •. N JO UIN LOCAL HEALTH DISTRICT ��-} f r- u 0 1 'AQ D- AAA