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FOR OFFICE USE: - 4l , -Z-(rO �} �7Z APPLICATION FOR SANITATION PERMIT 50-7—1 — ------------------------------------------ Permit No. ---- --- --- ---- - ----- --- ------------------------- (Complete in Triplicate) - / Date Issued ---I? This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereir described. This application is made in compliance with County Ordinance No 5.499 _2and existing Rules and Regulations: JOB ADDRESS/LO T A.� - - -------- --- - - ------ -- -- ---- -- el-_----------CENSUS TRACT ............... Owner's Name --- --- - �:_ - -- ---- -,.aCAr- - _� --------------------- Phone ----------------------------------•- o Address _ - _. City - Contractor's Name L ------ _- ,.License # Ci.` -Phone ______________________________ Installation will serve: Resident AP artmenfi se❑ Commercial ❑Trailer Court i❑ Motel ❑ Other Number of living units_____________ Number of bedrooms _____-______ rbage Grinder ------------ Lot Size -------------------------------- -..________ Water Supply: Public System and name ------------------------•--------•------------------------ I--------------------------------------------------Private Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ - (Clay Loam ❑ , Hardpan 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.) n NEW INSTALLATION: (No septic tank or se page pit permitted iif/Public4wr r isavailablewithin 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK' izet9_____�___ Liquid Depth -- q___________________ i Capacity _. _ __ ype • r_A Material__ _ __s_ No. Compartments __®��___ ___..... ` f ± Distance to neare Well ____._ ____________________Fatindation`__._ ! ________ Prop. Line ---r __�__......- ' LEACH WG LINE No. of Lines ________ _____________ Length of each line........I ' -----_____ Total Length ,_____` ....... 'D' Box a� ___ Type Filter Material --- ,s_:�_ .k_Depth Filter Material ______ ______________________________ Distance to nearest: Well --- Foundation ---IV-!_________-- Property Line ------ -------------- I SEEPAGE PIT [ Depth _. _c, --- Diameter _ _t'_____ Number ______._ _/__________- Rock Firmed Yes No Water Table Depth ------------V-Q------------------------------Rock Size ---- 3__-- Distance to nearest: Well ___________1Q __f.............Foundation -1-0............ Prop. Line ...... --------------- REPAIR/AD DITION ---___ _-___•-REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------------_---.-----1 SepticTank (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) -------------------------------•-------------------------------------------------------------------------------------•--------------- ------------------------------ ------------------------------------------------------------ - ------------------- --- -------------------------- ---------------------------------------------------------------------------------------------------------- ------------------------------------ - -- - (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. 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 Work Compensation la f California." Signed ---------- --------- -- ----- ---- Owner �,,�� -------J-- -------- . � 1L ,- - ----- -----ems . Title ---- �_ -'._ `�L' BY ---------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ----------------------------------------------------------- DATE % ' BUILDING PERMIT ISSUED ----------------------------------- -- ----------DATE ----------------_ ADDITIONALCOMMENTS ------------------------------------ ----------------------------------------------------------------------------------------------------------------------• • --------------------------- ----- - ------------- ------ -- ------------ - - :-- --------- -------------------- ---------•------ ------ -- - - ----- --- - - Final Inspection by: ------------ --------------------------------------Date .... �---- SAN JOAQUIN LOCAL HEALTH,,DISTRICT JVA�h E. H. 9 1-'68 Rev. 5M