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N 0,,. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ��_ � ---- - ------. . l ----- - t Permit No. --- (Complete in Triplicate) -.._.-____-_--_-----~ This Permit Expires I Year From Date Issued Date Issued 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. 5499 and existing Rules and Regulations: J08 ADDRESS/LOCATI _�_Oy�P�-j-----------w f - .-----4 wCCENSUS TRACT .......................... bwner's Name R `1` Cr�a - - •-------`• .............Phone - .......................... .- ,(�/}�'� �� "Z � -;I!-- Address C _ :. -- - City --- .. +c c>°tm -'` Contractor's Name .- -- -- tl. ------ ------ ------ - - - - - - - " - License __l�!3£l Y--- Phone ----- ........................ (Installation will serve: Residence ❑rr<partrent House[] Commercial QTrailer Court 0 Motel ❑other _.��..:........................ ......... Number of living units:........ Number of bedrooms -A..--...Garbage Grinder --..-- ..... Lot Size ---- ` ........--- Water�Supply: Public System and name -•------------------------------------------------------------------------------- ---Private Character of soil to a depth of 3 feet: Sand'❑1 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,❑ Hardpan lJ 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,) PACKAGE TREATMENT [ ] SEPTICTANK{ ] Size------------------------ -------___ -------- Liquid Depth -.......------...... ,.._. Capacity -...------. ------" Type----------------- ---- Material------ ....... ---- No. Compartments ...-............. ..--. 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_------------..............._............... i Distance to nearest: Well................... _{ Foundation ----_- --------- Property Line ................... PIT [ ] Depth -------------------- Diameter ..............T, Number _-. -------------------- Rock Filled Yes No .[] i Water Table Depth ------------------------------ ------"--------Rock Size Distance to nearest: Well -.........................................; Foundation ---------_-_'__..�:. Prop. Line .................... 1 REPAIR/ADDITION [Prev. Sanitation Permit°# ----------------------------- .............. Date ------.-----------.--..-------:--1 Septic Tank (Specify Requirements) ... - --- -----•--- ........-..._.................---- - - Dis al Field (Specify Requirements) ---- .. .-- '+Y- -- - ..... -- n ....... ---"-- -------� �- ......I_z ...... . g V (Dravdkisting and required addition on reverse side) I hereby certify that I have prepared this dppilcatlon and that the work will be done in accordanle with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local 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, 1 shall not employ any person in such manner as to become •ect to Workman's Compensation laws of California." Signed ---------- --- Owner ------ ------ —�^ By _..-... 1t t G- t� _ Title _�_ Gil w - -------- .................. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ->- ------ --- -----.. !----------------- DATE y-�_�:z----•- a---- BUILDIN& PERMIT ISSUED ------ ------------- ------ .........................................`--------- ---DATE ADDITIONALCOMMENTS ------------------- ----- --------- ............................................ --------------- .................................................... ------------------ ------------------------------------------------------------------------------------' --------`------- ---------- ------------------- ---------------- -------------------------- -- ------------------ ------------ - ------ /1.� a.� Final Inspection Date --------- ---- - --J�- -- C- - - SAN J AQUIN LOCAL HEALTH DISTRICT