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At FOR OFFICE USE: , ! APPLICATION FOR SANITATION PERMIT Permit No. r --j-- / � (Complete in Triplicate) -----------------------------------�� Date Issued �. This Permit Expires ] Ye`&r From Date Issued ----= Application Is hereby made to the Son Joaquin Local Health'District for a permit to construct and install the work herein described. This application is made Irr°compl,ance ith'County Ordinance No. 549 and existing Rules and Regulations: { - CENSUS TRACT --------------- ----------- JOB ADDRESS/LOCATION l------- . 1---------�.-`--- ` # - Owner's Name ---t-111) ) n------- T=�------- -�71 ; Phone Address --------- S y� ---------------------- # CS 1 '� Phone ------------ y � '�� Contractor's Name --- i�----------- ------ -� .License # i installation will serve: ! Residence. Apartment Hause❑ Corrimercinl OTrailer Court i❑ Motel ❑Othdr'l--------------------------------- i Number of livingunits:____2'� \3 a. 1 Lot Size __�� - -----x__---�-�© t '' ___ - Number of bedrooms ___i--_____Gar:bage Gnndtsr _---,--,- I) t_ t l�`, { �-------------- 'Pea---------Sandy Loam lam-- Private ❑ Water Supply: Public System and name ---------�'.= _ _ Character of soil to a depth of 3 feet: ?Sand'Q Sllt❑ I Cay ❑ ❑ Q Clay Loam;(] m Hardpan E] AdobeiSa Fill- Material . -------- If Yes, type --------------- �Tf 7 buildings, etc. must be placed on reverse side.) - (Plot plan, showing size of, lot,`'location of'system in relation totwells, NEW INSTALLATION: (No"septic tank or seepage piJ permitted if,�public sewer-is available within 200 feet,) y !' $..Size-------=-------- ------_.—---- --------- - Liquid Depth ---------------- --- PACKAGE TREATMENT { ] SEPTIC TANK'[ ) ` Capacity -------------------- Type --------------- Material---------- --4= No. Compartments Distto nearest: Well ------- ------------ -------Founda ion �-------------------- Prop. Line .----------- --------- _ 1 LEACHING LINE q No! of Lines --------- --------- Length of each line---------- __0-.--- -- Total Length -----�.��---•---------- I �-t----- .--------•- e 'r 1 Box __:_�__ Type Filter Material �L4-Depth Filter Material _____________ __ _ J Distance to nearest:"Well p nJ C Foundation Property Line --------- ----- -------- __! 1__________ il ___ ______ Rock Filled Yes No Q SEEPAGE PIT Depth ----- =}--- -._ Diameter ----33------ Number ------------ - __ 1 Waiter Table Depth --------------�c�t------------------------Rock Size ----I-- -------------- Distance to nearest: Well _____- v�'- ---------------...Foundation I- - ----- Prop. Line ..___S._..____-__--- ;M # REPAIR/ADDITION(Prev, Sanitation Permit# -------------------------------------------- Date ------------- ) - '! Septic Tank (Specify Requirements) -_----- ------------ _ Disposal Field (Specify Requirements) _Ck'------- I . 4 ---------------------------___------------------------------ _________________________ - /lt7 t `;-3-------------- -- «' ------ G (Draw existing and required addition on reverse side) I hereby certify that I have preparedithis 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 LocaljHealth District. Home owner or licen- sed agents signature certifies the following: I "I certify that in the performance of the work for which this permit is issued, t shall nt employ any person in such manner as to become subject to Workman's Compensation laws of California. 3, er .. . ---- -- ...r....,�• -----� ---------��'�-----�--- Own "^"""""` -•.-O Signed ------ ---------- - _ ___ . (If other than owner) ,, Il FOR DEPARTMENf'USE ONLY ti � 'I ----------------------- ---- -------- --------------------------------� DATE ---- ---�- --------- -------rte--------- APPLICATION ACCEPTED 'BY --- --------- ------------ -- -- ----- - ---------__--i ------ --F------------ ------ '- DATE -------------------------------------- BUILDING PERMIT 15SUEl? _____--------------------- - --------- - - I t t - i ------------------ ADDITIONAL COMMENTS _ F ------------------------------------------ _ ____ ________ __ _______ __ __ ___ ___!'______ ____ _______-__________--______ ____________.______________--_'_____--____-__----_______g_-__________-___.______--________-________________.__________ ____________________________________ 1 i 1 ,, -- ------- _� t � .� ------- - r i Date Final Inspection by: ---- - -- ---- --- ----- - ---- i AN JOAQUIN LOCAL HEATH ,DISTRICT r- I E. H. 9 1-'a8 Rev. 5M