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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT; ----------------------------- ,', 1,� ( (Complete in Triplicate) A Permit No. ---------------------- - -----------------------:----------- 'l 1. --------------------------------------------------------- This.!prmlt Expires ] Year From Date Issued-,-/ Date Issued -r76-7-3. f � Application is hereby made to the San Joaquin;Local Health District for a,.per�to construct and install the work herein I described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: I JOB,ADDRESS/LOCATI N .. �l!-7I ` CENSUS TRACT Owner's Name � 404,67 ---' - Phone 03-7.4----- Qp_Address ------- kms .-- --- - - - City ----------------------- --•------ ! Contractor's Name _�f.=_ --_----- _=_-_-- - `+ - -�-__--=--Y.-------License # / - _1l_.._ hone 4'✓�- lnstallatiort ,viii))-serve: Residence NfApartment House❑ Commercial ❑Trailer Court ❑ I Motel ❑ Other ----------------------'----------------R Number,-•of-,�living units:--. ------ Number of bedrooms ---3-----Garbage Grinder�T'Z�'Lot Size -___ _--_-_-_.___-___-----_--`---_..._--_ Wtelr Supply: Public System and name ---------------- ---------------•------------- I---------------------------------------•----- ----------------Private. Character of soil to a depth of 3 feet: Sand Silt Clay E] i Peat E] Sandy Loam ElClay Loam E] ~— t l Hardpan Adobe Fill Material -------------Ifes e -------- ------------------- -------------- k wJ� J*� " (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed }o'ti reverse side.) % t O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 1200 feet,) t� .��.- IND PACKAGE TREATMENT ["]3 SEPTIC TANK: Size____�__X_C,7_------------------------ Liquid Depth -_4ey.---. ---_--_ \ t, i . , . Capacity TypeMaterial _lys'-1 No. Compartments ._.. __..___..__ Q Distance to nearest: Well ----------- -- ------------------Foun ation _�---___--_ Prop. Line ___-S._.' _ �R I LEACHING LINE No, of Lines --------�-------.-- Length of each line-------/-C>-2)--_-.--.--_ Total Length --- ........... ! 'D' Box __--✓_ Type Filter Materia! l4 _--_-Depth Filter Mater al ___l. ........�_ _--____-- i Distance to nearest: Well -------f ------ Foundation -----/_0__ ------- Property Line SEEPAGE PIT' ]' Depth ___?!a___--_____ Diameter --,?Y------- Number _- __ ------�-_—.1 Rock' Filled Yes No 0� .,,` ��; ..r---► ri . � �, �. ., I _ � Water iTable Depth --------------------------------------------._.".Rork gize �w---- --------'-----•- Distance to nearest: Well_------- ----------------------Foundation Prop. Line _--_ .......... REPAIR/ADDITION,(,Previ.Sapitatign-Perrnit# -------------------------------------------- Date ---------------------------------- Septic -__.-..---_---_-------__-____---Septic Tank (Specify Requirements) ---- ----------------------------------------------------------•-------------- -----------------------------•.------------------------------ Disposal --------------:--:- ------Disposal Field (Specify Requirements) ------_-_--_ ----------- ----------;--- ------------------- ---------------------------- I ------ ------------------ -- -----`- --------------- } --- - ------------ --------------------------------------•------------------- ------------------- I ------------------------------------------ I -- (Draw existing and% eqiyiree�gddition'dn reverse side) 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. 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 - 9t---------------------------------- ------------ -- -- - - - ---------------------------------- Title ------- (If of ee an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- amu -------------------------- - ----------------------------------- DATE ` - ------------------ BUILDING PERMIT ISSUED ------------------------ -- --- - ` -- ----------- ----------------------------------------------------DATE ----------------------------- ------•--- ADDITIONALCOMMENTS ------- --------------------------------------------------------------------------------------------------------------------•----------------•------------.._. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ ----------------- ----------- r ---------- ------------------------- ----------- •--------------------- Final Inspection by: Date --- -_-- SAN JOAQUIN LOCAL HEALTH DISTRICT W( ,, E. H. 9 1-'413 Rev, 5M