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FOR OFFICE USE: + ' APPLICATION FOR SANITATION I AMOr r ----------- - ---------------------- Permit No.'34 jr,�C ;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 in compliaffe with Co y Ordinance No 549 and ex tin/Ruie Qhd Regulations: i / 0 ` --------------....--____-- JOB ADDRESS/LOCATION1 ____.v - NSU S TRA CT Phone, +----------------------- Owner's Name / ` city !7 C �--Addressi � Contractor's Name - °= ® ==- ------.License # -- 7-------------------- --------------- - Phone ------------------••------- Installation will serve: ', Residence XApartment House`[] Commercial :❑Trailer Court 0)-Motel.[]Other -------r- T --------------`-=----- r _Is�l Number of living units:_____) Number of bedrooms1�.___Garbage Grinder_____________ Lot Size __ '- -- ---------- •--•. Water Supply: Public System and name -----------------___-'-_-'"-------------------------------- PrivateK ------------------ - --- Character of soil to a depth of 3 feet: Sand'F Silt❑_n Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ �+ 1 .. _. i_ .. - ____ � tm� Hardpan TAdobe F1Fill 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 see age pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ ] SEPTi IC T NKSize_____________________ -- ------ Liquid Depth -----------__------.------ Capacity ! � Type _L�:E'_______ �atenal__ !`- No. Co partments --------- . 0 __" Distance to nearest: Well ------- � ________________Foundation -___Ae Prop. Line ------�--- ----- LEACHING ._- , LEACHING LINE No, of Lines --------- Length of each ine______-_�u-_ _ Total Length _______ -- X -- f 'I)' Box __ __'_.___ Type Filter Maten epth Filter Material ________ � s- -------- Distance to near Well -__-- Fou ation _____69c____ Property Line -_____ ______________ SEEPAGE PIT „ Depth ----4�Diameter --3;$______ Number -----�--------------�_, Rock Filled Yes No .0 Water Table Depth _____________p-� li.P--____Rock Size ----- Distance to nearest: Well _______-- _ __ ___t____-_____Foundation -- !,---, Prop. Line .._y ..•- 1 REPAIR/ADDITION[Prev. Sanitation Permit K# -------------------------------------------- Date ------------------_•--_----------I YSeptic Tank (Specify Requirements) ----------------------------------------------------------------=-----------------•------------------------ --•. ----------------•--------•- Disposal Field (Specify Requirements) ------ ------------------------------------------------------------------------------------------------------------------------------ -------------- - ------------------------- --------------------:--------------------------------------------------------------------------------------------------------------------------- - ------------------- 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, I'shall not employ any person in such manner as to'become subject to Workman's Compensation laws of California." Signedt.`--- ----------------- --------------- Owner BY / - - Title - --------------- ---------- (f other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------r --------------------------- DATE ---- ---- ----j7v------- BUILDING PERMIT 155UED ___ 10 DATE _._______ 2 ---- -- - -- -- - - ADDITIONAL COMMENTS �© Zrla� ---------------------- --------------------------------------------------------------- ---------------------------------•------------------------------- -------- tt --------------------- -------------------------------------------------- ---------------------------------- ` - ----------------------------------------------------------------------------- ----- Final Inspection b ! Date -------- -- - -- 4 ----------------- PY; ------------ ---- ---- ------ ------ ---- ---------------------------- ---- ----- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT f E. H. 9 1-'b$ Rev. 5M