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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -----------------------------------•--------------------- _ (Complete in Triplicate) ---------=----- - ------------------------------ Date issued - =-7`�•� This Permit Expires ] Year From bate 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 compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION __aS—o�--7- ------ p �.� - CENSUS TRACT Owner's NameJ_ ------------------------------------------ ------- - ,p one t Z� --. Cit T - -------------- Y ----- Address ----------------- 93--T--'---- -- l` -------_ '� � ----------.License # -oZr -gs�b- Phone -- `-7. 1 ----- Contractor's Name ---(I --- -- '"=- Installation will serve: Residence [�ortment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other ------------------------------------------- 62 Number of living units------t----- Number of bedrooms ---- _--_Garbage Grinder -----Y------ Lot Size �o�.ry," -- Private E]Water Supply: Public System and name --------- -4- 114 -----�"""".-"-"'L[ Character of soil to a depth of 3 feet: Sand-'[;5 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 seepa pit permitted if public sewer is available within 200 feet,) SEPTIC TANK Size___ --- - --- Liquid Depth _- ----------- PACKAGE TREATMENT { ] "�X-"-- """"--�"----- •---"---- q p .fsr+r�`"'"---- Material"- -- - No. Compartments --- ------ ------ Capacity --fS�r� ----- Type D , VI Distance to nearest: Well __!�Zoa-----------------------Foundation �___----------- Prop. Line -5----•--•----- LEACHING LINE [ No. of Lines -----1"_4-------- Length of each line------,,.�-7� _ Total Length ___ ------f 'D' Box _�------- Type Filter Material ---1 ----------Depth Filter Material ---- ----- ----- - -, Distance to nearest: Well --------- Foundation ---_/ .----(----------- Property Line ----15 ------ -------- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number --------------------- ------ Rock Filled Yes © No ❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well __---___.--"-_----".- ------- ----------Foundation -------------------- Prop. Line ----------•---------- - REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------""""""-------I Septic Tank {Specify Requirements] --------------- -----------------------------------------------------)(------------- ------ Disposal Field (Specify Requirements) ---- 1_11q_E� ' "D --------------------------------- ------------------------ ----------------------- -----I-------------------------------------------------------------------------------------------------------------------------------------------- -------------I-------------------------------------------------------------------------------------------------------------------------------------------- (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 shah not employ any Person in such manner as to become subject to Workman's Compensation laws of California." 1�'0. -•-e ,I Owner Signed - - - '-..�- �--�-----�-�'------ -�--------- _ /�y_ /� - -- --------- Title{------ - ---- ------ --------- -------- B L'�.-'E-------- (If other than own r) FOR D 4ARTMENT USE ONLY APPLICATION ACCEPTED BY .--_��- ��--------------- - DATE --, .-Z-. - BUILDING PERMIT ISSUED ---------------- -------------- -------------------DATE ------- ADDITIONAL COMMENTS -- --------- ---------------- - --------------------------------- ------------- ------ ---------------------- -- --- ---- --- ---- -- ---- -- - - ---------------- - ----- ---Fnanspecti -------- Final Inspects Da#e SAN JOAQUI LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M