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;FOR OFFICE USE: APPLICATION FOR .SANITATION PERMIT �93 - Permit o. - Pit N (Complete in Triplicate) ------------ This Permit Expires 1 Year From Date Issued Date Issued ___ //Q_A_4. 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.Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI N _- - _1 .[�L- --- - s- ;r----------- - CENSUS TRACT -------------------------- 1 t Owner's Name one -------------------------- ----- ------- - --------- Address l ----------a^ . CifiY . --- ----- -------- Contractor's Na - icense # _ dr� Phone . Installation will serve: Residence partmen House❑ Commercial ❑Trailer Court Motel F] Other ---------------G- . •__ r Number of living units:__________ Number of bedrooms. �_ arbc e Grinder ---------- Lot Size ---1- f ------� - --r- --------- Water Supply: Public System and name ---------------------------------------------------------------------------------------------------- ---------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ }-Hard an r t p ❑ Adobe "Fill Material ------------ If yes,type __________________________ :I .< (Plot plan showing size of lot, to, of system in relation to Wells, buildings, etc. must be placed on reverse iside.) NEW INSTALLATION: (No septicf tank or seepage pit permitted if public sewer is available within 200 feet,) s PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size----'---—--------------------------- ---- ------ Liquid Depth -- .----------__--- i { Capacity ----------- ------ Type --------------------- Material------ !------------ No. Compartments ------------- -•--.... t Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- LEACHING LINE [] No.,of Lines ---- ------------------- Length of each line-------- ___________________ Total Length ---------------------------- 'D' Box -_!--------- Type Filter Material ------- ------------Depth\Filter Material ---------------------------------•---------- Distance _-_------ Distalce to nearest: Well -____- ------ Foundation ----N_--------------- Property Line ------------------------- SEEPAGE ____._______________ __SEEPAGE PIT C ] Depth - ________ _____ Diameter-.__------ _____ Number ----------_----N----------- Rock'Filled Yes [I No C] ) f Wates' Table Depth ------- ---------------- }--------------------Rock Size ------- Distance to nearest: Well_____________________________________---Foundation __-__-- Prop. Line ____.__-._..__ - r' t h REPAIR/ADDITION(Prev. Sanitation Permit# --------._-__--_________----------------_ Date ______________-_____ ____..______) r i Septic Tank (Specify Requirements) -----------------------•--------------------------------- ---------------------- Disposal Field'(Specify Requirements) ---�_/'�rs.�nerrr_.r._��zct-^_.:------ ---------- �s.�--�----�--,�.�„�---�,_,---•--------------- ",. -1 I ---------- ---------------------------------------------------- ------------------------------------------------ - --- -- ---- (� (Draw existing and required.,addition on reverse side) ) �.af`� I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin w:' 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 far which this permit is issued,'I shall-not employ any person in such tmanner . i as to beco a su t to,Workmcin's Compe sation laws of California." Signek -1G ---------- ------ BY -------- = A Title ------- t (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___.____ - -------- - DATE BUILDING PERMIT ISSUED I:- - - DATE ADDITIONAL COMMENTS ----- ---r _ ----if /_af`°- ----------- - ------4--------------------------------------------------------------------- ! -- - � --------------------------------------------------- - _t_2- -------------------------------------------------------------------------------- � e �_---Final Inspection by: --------�--- ----- ----------------------------------------------------- -------------- - - -------- ate ___. --a- -- �------ -� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ,