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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---- -------------- ----------- ...-- ...._ (....�'-,S - f '- (Complete in Triplicate) --- A ...• p Date Issued :�? �6 This Permit Expires T Year From 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 Cou ty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. ----CENSUS TRACT ..._---. .----- - Owner's Name Address .\c'a ,......1�4Res,d!ence?Apartment -� ....... City ...a-Irla -��.. ,,te�nn -C.License # ...-4U_0_�j6Phone ............ ----------------- Contractor's Nam�x�.� � --��- '- � , Installation will serve: House❑ Commercial i]Trailer Court ❑ Motel ❑Other .--- -••- ----------- ------------ -- Number of living units: ........ Number of bedrooms _� .__Garbage Grinder __..._._ Lot Size .......,.- ....:.............____. ----- Water Supply: Public System and name __.. -Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam' Clay Lo dm [] Hardpan ❑ Adob 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 for seepage pit permitted if public sewer iis/s available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAIINK 0 Size.._-- _y. O- .�t- Liquid Depth.. --- -- ---•-- O Capacity Type F -- Material No. Compartments .__.. ......... �®_,�r_... . ,ar-.__ 01 Distance to- ntsarest: Well ...... Foundation �_O. .- Prop. Line -___.- 0-l-•--- •----•... oo - hiLength of each line_. S- 19 - - ------ Total Length ...-..�.�?_�__�- LEACHING LINE No. 'of Lines --- --=- ------ �� De th Filter Material --J. 'D' Box __1.._._... Type Filter Material p ,1 .: i ... Property Line ... .Q_._.:..__ Distance to nearest: Well��---- - ---- Fo dation Depth ( Diameter _'.:............ Number_. .....____-_. ----------- Rock Filled Yes '❑ No i❑ SEEPAGE PIT [ ] p - --•-------- t i f Water Table Depth _-_--'Rock Siie`�' .-..------. •------ i I ~__Foundation r -•------ Prop. Line ---_------•-••--•--- Distance to nearest: Well _ ____________ ______________ - t REPAIR/ADDITION(Prev. Sanitation Permit# ----------- •. --••-- .... Date Date ______._ ---k-------------•-- •-•1 Septic Tank (Specify Requirements) ----- _ .--. _ ----------- ------------ ..... .................... ;4 Disposal Field (Specify Requirements) ----------- -- -- ...... ........... -------------- ------ 1 - --- ......... - i ____ ----------- ----. .. -•------- ------ ------------ ------ ------------ (Draw existing and required yaddition 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 becWp blect to Wo kms Compensation laws of California." s �` SigneSD "z{_. v .�.L..1..-- - - c Title __....._.... --------- (If other than owner) FAR .DEPA LEN, USE ONLY - APPLICATION ACCEPTED BY __._.. DATE BUILDING PERMIT ISSUED ------.--•- --------------- - -.-DA ----------- ---------•-• ..------ •----- - .. .-------- ADDITIONAL COMMENTS --------'I -----------• -----•------- ------- ----- ------------- --- • -- •-•-----•-- ---------- --- I ------ ---------- I- ------------ ---------- -------------- ------------ ........ .......... - final Inspection by: --_-• Dat _..... -_l' .........-------4- . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M. ` 6 . E —