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Y _ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: -Z=-- -�-�' ---------a---------—------------- ------------------- (Completin Triplicate) q --- ------------------------------- Date Issued --._( =�= This Permit Expires f 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 County Ordina ce 549 and existing Rules and Regulations: _ -II__CEN tUS TRACT --------------' JOB ADDRESS/LOCATION .--Phone `c® �' 6 _. — �4-- -- ----- Owner's Name ..--- ---------- --- :.N Cit - V'4 �7tr.-------------------------------------•---...--•-- Address __0 `� '' 'YP II a License # _71-'T- - ---- Phone Contractor's Name -------- -- -- -`-- Installation will serve: Residence PApartment House-❑ Commercial ❑Trailer Court `,❑ Motel ❑ Other ----Garbage Grinder Lot Size------ ------------------ r----- --------- -t �__ N Number of living units.----/--- Number of bedrooms ----s.� 4 It y - t 2t 1 ---...?` '�--------------------------------------------- Private Water Supply: Public System and name _ _ _. - Character of soil to a depth of 3 feet- Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay LoamX] Hardpan E] `Adobe 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 or seepage pit permitted if public sewer is available within 200 feet,} - r �I PACKAGE TREATMENT [ ] SEPTIC TANK' Size---_,6- :-s-----X-10------------- Liquid Depth ---_c5----------------- �+ F� No. Compartments -_- ----------- �' Capacity� _.r ._ Type " ` Material_ __s ��- � ___ Distance to nearest: Well ... ----------------------Foundation ---- _ -------- Prop. Line _---_--- �s? ° Total Length _34AP-------------- LEACHING LINE No. of Lines .__-Z--------------- Length of each line_.___ ____ _____- ---- g 'D' Box .-/------ Type Filter Mate rial•_ 4"-C. -------Depth Filter Material -- -- - ----------------•------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line. ----------.-------•-• SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------ -----------Rock Size ----------------------------- -- ' Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------------_------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ____.-___,_-----------------------) Septic Tank (Specify Requirements) ---- ------- --------- ------------ -------------- ------------- -----------------------------------•---------------------------- Disposal Field (Specify Requirements) ----------- ------ -------------------------------------------------------- ------------------------ -------- ---------------- - ------------------------------------------------ ----------------------------------------------------------------------- ---------------------------- (Draw existing and required addition on reverse side) 1 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 Title --- By '` . (If other than owner) , FOR DEPARTMENT USE ONLY ¢ qr DATE -- APPLICATION ACCEPTED BY Z5!` BUILDING til / BUILDING PERMIT ISSUED --------------------- --- -------DATE -------------•---------------------------- ADDITIONAL COMMENTS --------------------------- ----------------------------------- ----------•- -------------- -------------------------------------- -------------------- ------- ------------ -------------------------------------------=-------------------------------------------------- -- . ; ---------- ----- --------------------------------------- -- Final Inspection b -'--- - - -- -- ----- Date `� SAN JOAQUIN LOCAL HET DISTRICT E. H. 9 1-'66 Rev. 5M