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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------------------------- ----- (Complete in Triplicate) Permit No-_7_ : .____ ------------------------- This Permit Expires 1 Year From Date Issued Date Issued _ _________________ , Application is hereby mde/Fo 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. 5.49 and existing Rules and Re Mations: JOB ADDRESS/LO T�IOr ' v �41 A. ---a } - CENSUS TRACT _____________ Owner's Name --------•----------------------------------- -----------------Phone------------------------ .....- Address . � � j� 2 C r --------------- city Contractor's Name ._ A�C =.License # /� ----- Phoneme installation will serve: Residencertment House❑ Commercial :❑Trailer Court 1❑ Motel ❑ Other --------------------------------------------- Number ------------- -----------------------------Number of living units--------- Number of bedrooms __,_ __Garbage Grinder__ Lot Size�> L_� X___ ---------- Water r__ _Water Supply: Public System and name =---------------------------------------------- -•---------Private [ ` Character of soil to a depth of 3 feet: Sand'E] Silt❑ Gay ❑ Peat❑ Sandy Loam ❑, Clay Loam ❑ Hardpan ❑ Adobe Fill Material" yes;type - -� �- ---------------------------= (Plot plan, showing size of lot, location of system ,in relation to wells, buildings, etc. must be placed on reverse. side.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) f PACKAGE TREATMENT [ ] SEPTIC TANK ze______ dSrX___ Liquid Depth ' __ -------------- y _-'-- P_ -- No. Compartments __� ------------- k Capacity I o --`-- Type -- ----_. _ Material---- �G p Z Distance to nearest: Well ----- --------------------•Foundation ------------ Prop. Line ___: --_--__________ LEACHING LINE [ No. of Lines _--__ —:�_._________ Length of ch line----��_ _ Total Length ......... 'D' BoxIto �3_.__ Type Filter Material /elk____Depth Filter Material ------------------------------- DistaD nt nearest: Well _____;�__'________ Foundation elo__I--___-_____ Property Line ___�---_____________ SEEPAGE PIT Depth __ -__� _ _ __��_„a�-___ Number -.-___--- -----______ Rock Filled Yes-W No i❑_ . [ p �.�__.__ __ Diameter Water Table Depth _----��--------------•-•--•--•---_-•--..Rock Size --`Lt: ---- Distance to nearest: Well ______ ___f__________________Foundation --- 1-L9-e.y,_ Prop. Line.S-_r_____:_--- REPAIR/ADDITION{Prey. Sanitation Permit# -------------------------------------------- Date ----------------- ............... Septic Tank (Specify Requirements) ---------------- f Disposal Field (Specify Requirements) ------------------------ --------------------------------------------------------------r----------------------•---------------------------------------------- f f - - _ x (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 i.ioaquin 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." . iI Signed --- ----- -------------------------- --- ------------- = Owner BY `� - Title ----- - i3 �{ " (If other than o n r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY I Y!/L Gds--------------- -- ---- DATE 3 7 �� BUILDING PERMIT ISSUED ------ --- --------------- ------------ -----------------------------------------------------------------DATE ------------------------------------------ ADDITIONALCOMMENTS -------------------------------------------------- --------------- ------------------------------------------------=-------- ------------------ ---------- - --------------------------------- ------------------------------------------------------ ----------------- ---------------------------------------------------------- ------- - - ----------------------------------------- - i ---------------------------- -------- '--------------------------------:--------'-- ---'------ - - - 9 Final Inspection by. - 9 -7.;;t_�---Z�- ��---- - SAN JOAQUIN LOCAL HEALTH DISTRICT E_ H. 9 1-'6B Rev. 5M a, y