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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT `% �_e Permit No: (Complete in Triplicate) - -_--- Date Issued -------- -------- This Permit Expires 1 Year From Date Issued , 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: `," 1 J� JOB ADDRESS/LOCATIOCENSUS TRACT Owner's Name - - ----Phone —� - Address -------- --. - _ .. .�._.. & ----------- City 7-------•--.-__.............. Contractor's Name --..__... -- >�- t�`------------------------License # I------- Phone 6.- ��'-------- Installation will serve: Residence ❑ Apartment House Commercial :❑Trailer Court ',❑ Motel ❑Other ----__ �------------------- Number of living units:------------ Number of bedrooms ----------_.Garbage Grinder ....____.... Lot Size - y '� ----------------- Water Supply: Public System and name ------------------ -------------___-------------------------- -----------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ 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,) rr PACKAGE TREATMENT [ ] SEPTIC �`t�TANK� p TSi-ze_5--�1 b----- g-------- Liquid Depth _._��-._..------- Capacity� 149q Type .F-CG_I....... Material_-�¢v1 L.e�.Na. Compartments ...';4-f-......... Distance to nearest: Well ------1aq ---------Foundation ..- ----- Prop. Line LEACHING LINE [ ] No. of Lines --._ � Length of each line--------------- -- ( --,•.......•. -----____-- Len �----____-- Total Length __1+/?__._ ,�. aDQxstrvA& 'D' Sox ...- Type Filter Material _>� -__._Depth Filter Material _./�_ ___-___----------------- D � . r X gp Distance to nearest: Well ._._h_f__-_-.-. Foundation ___Q_-f___.._.._ Property Line S-_f_____________ SEEPAGE PIT [ }_ Depth -------- ----------- Diameter ---------------- Number --------------------- ------ Rock Filled Yes A No C � YD Water Table Depth ------------------------------------------------Rock Size ---------------------- ------- Dp/41AJ S W W T Distance to nearest; Well ---------- k2_._ f'..............Foundation Prop. Line ....._�_"f--__- I- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------.-.__.._._--------------) SepticTank (Specify Requirements) ---------- -----_------------------- -------- -----------------------------•---------------------------.------------- ............... DisposalField (Specify Requirements) ----------------- ------------------------------------------------------ -----••-------------------------------------------- --•--- ----------•--------•------------------------ -------- _-------- -----------------------------------•---•----- --•----------- (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." L Signed ------------- Owner cd ------ Title -----..... t-•---------------------------------- ---- -- -------- (If r than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -`� - --------------------------- -----•--..---------------- DATE _- f ] BUILDING PERMIT ISSUED ----------------------------- - -- -------------------- -- - DATE ... . ADDITIONAL CO ENTf�, �t�-f�-C�+�-�x-�/`�:P, �*7._�--'n--(��.4'+G.rt�d"--�4�-i�ee?a_ G�_..rL."r? yo.d•-.-�"-`---------• .--------- -`-------------------------('/ fi-------...-------•---.-.-.------------------------------------- -- ..._..f. ----------------------------------------------------- --------------•-- --------------------------------------------- ------- ........ ............... FinalInspection by- -•------------------------ --_--------------- ----------___------------- ------- ------- •------------Date .------- ------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'S8 Rev. 5M