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r s FOR OFFICE USE: '+ 1 APPLICATION FOR° SANITATION PERMIT . Permit No: a a (Complete in Triplicate) ---------------------- ---------- ----------- This Permit Expires 1 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 incompliance with County Ordinance No. 5.49 and existing Rules an Regulations. •�'; +�f :a4-,r� ,P�-• �-jam' � ' so `13 9330--3 '. �B ADDRESS/LOC ON ---- = x4e��,6__V___CE14S6S'TRACT a ------- .- -----------------==w. =r _Phone ---------------- ----------------------------- Owner's Name -- - - --- ----- - --- -zle -------- - Address /Q---- -GJ---- 4 lv t � +Contractor's Name ------- ------------- W------ ------------------------------License f / Phone A Installation will serve: Residence partment House-[] Commercial ❑Trailer Court >_ Motel ❑Other -------------------------------------------- - �, Number of living units:-_____ _- Number of bedrooms _____,_Garbage Grinder)/_ Lot Size ----------- /%Nater Supply: Public System and name ------ ---------------------------------------------------- -----------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay E] Peat El Sandy Loam (�f Clay Loam El� F Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (PlotYplars'Tshoowing-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 iff public sewer sewer is available within 200 feet,) f PACKAGE TREATMENT { ] SEPTIC TANK ga _ i _ -_! ,/ _ __�--- - ------ Liquid Depth ____ J-_-- Capacity f- ------- T pe � 5 *_-- Mbteria} >. ?��" ..�Compartmen#s ----_ --.:.... 1 X77 � Distance to nearest: Well?Lc� ----------------------•Foundation�_ Q-----__-___Prop. Line __ .___________ LEACHING LINE, �y� No. of Lines __-�)I_____________ Length of, each line.___�+�-- �s�otal �E�ength � .____________ Yo � D' BoxY0_ e-� Type Filter MaterialZ �� _ _ _- rre th.Filtef Ntateriai-_' f� D P �1 r ----•----•- Distance nearest: Wel __ --------- Foundation ____. 'Q- ------- Property Line. ----------------.--_-___ Depth � er _____________= Number _.__:__�_____________ Rock.,filled Yes � No ❑. { Water Table Depth --- ---------------------- -----Rock Size -_fes Distance to nearest: Well _________________________Foundation ____ -.--__ Prop. Line _____ REPAIR/ADDITION(Prev. Sanitation Permit# ________________ ---------------------- Date -------------------------- -------1 Septic Tank (Specify Requirements) ------------------ ---------------------------------------------------------------------- DisposalField {Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- 1 . ----------------------------------------------------------------- I J (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, 1 shall not employ any person in such manner as to become subject to Workman's`Compenscti;on laws of-California." Signed i ------------------- - ---------------•I----------=--(Owner By ------------------- - ------ ------\---------------- Title ------ -- ------------------------------ --- (If er than owner) E RT ENT U NLY APPLICATION ACCEPTED BY - -------------------------- DATE --- �.`--- ------ ------------ BUILDINGPERMIT ISSUED ----- --------------------------- --------- ----------- -------- -------DATE ------------------------------------------ ADDITIONALCOMMENTS -----------------------------------------------r--�-�-----------------------------------------------------------------=--- ----------- --------------------------- ------------------------------------------------- -- -- --- �y------ ----------------------------------------------------------------------------------------------------- ------------------------------------------------------------ - - - - -------- Final Inspection b Y"--E-- ----- - -- --------------------------- ------ Date tjj P Y� ---------- - - -- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.