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.v.♦ Yi'F l�.l. VJI�: APPLICATION FOR SANITATION P tT -- - ---------------- ..._...----------- - (Complete In Triplicate) Permit Nb. ... �_� ...........................................•............. This Permit Expires } Year From Date Eseuad Date Issued .. Application is hereby made to the San .Joaquin Local Health District for a permit to construct and Install the work described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulotl 7,. JOB ADDRESS/LOCATION .._ � _.._.. J .........CENSl15 TRACT ............... _ Owner's Name .. �� E� ``�r' I --...._.. Address ^_...........V.�..:�. ^.....Phone _..._._. . -- ..... ... .a`-.7 .......... City .... .. .. ? r� ....................... Contractor's Name , �q��-_- �• � ,r1 --'••---- J ----- --- •- •License # �� '2.... ....................- ....... - - Phone Installation will serve: Resident Q Apartment House Commercial oTrailer Court ] Motel ❑Other_1/--•...�.. _ : Number of living units:-.._-_.---_ Number of bedrooms ............Garbage G_ der Lot Size Water Supply: Public System and name --__ ...... G -. ..... ...... .. - ..... .... - ---•--•----•................................•--- - Private [] • Character of sail to a depth of 3 Jest: Sand 0. Silt 0 Clay 0 Peat 0 Sandy Loam 0 Clay loam 0 Hardpan 0 -Adobe l] Fill Material ............ If yes,type............::. (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. rust be placed on reverse yl r NEW INSTALLATION: tle'�' (No septic tank or seepage pit permitted If public sewer is available within 204 feet,i PACKAGE TREATMENT j ] SEPTIC TANK{ ] Size................................................. Liquid Depth .................... Capacity -_-- Type ------- Material------------------- - No. Compartments Distance. to nearest.. Well .-------••--- ---------- •.._....Foundation ...................... Prop. Line .------•....._,:. LEACHING LINETotal Length [ ] No. of Lines ------------------------ Length of each line.--------.------ 'D' [lox ............ Type Filter Material ....................Depth .Fitter Material ........................... Distance to nearest: Well ........................ Foundation ................... Property Line ................ SEEPAGE PIT { l watch Table Depth Diameter••••••-------^----'--NumbeRock Size .-.__-.•---••_. Rik Filled Yes 0 No � .. Distance to nearest: Well ------------_- ------------ --------.Foundation .............. Prop. Line REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date ........ . Septic Tank (Specify Requirements). ________________ Disposal Field (Specify Requirements) r ...-----•--••--------------------•------.......-----••-•--.... .. .. - ---- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Sart Joaquin focal 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 become subject to Workman's Compensation laws of California." Signed ------- ----- Owner SY - --- --------- - itle - 'Z ' ......... -• ------- - {If other than owner) s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .._ -.-, -_---11....T - DATE ..5. --.Z - ..7.b- BUILDING PERMIT ISSUED ------------- DATE ADDITIONAL COMMENTS ---------------•--- _- - ----------•------------------••------------------------ ----•------------------ ----------------------- ------------ ..........---- --........ ---- -- ------------------------------------------- ----------•---•------.._...--------- ----------------- -- ................. ------- ---------- - ----- --- ----- ........ --•----- ---- ------ ------- ----- ----------------------------------------------- ------------------------------------ -------------¢ Final Inspection b P Y� •��- -- -•---•----•-•--•--•-•--------•..................•-----•�------...=----• • •---....-----"..Date f/..2. ..��........._.. . ........ EH 13 2b 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M