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FOR OFFICE USE: pppLICATION3''FOR SANITATION PERMIT i . (Complete in Triplicate) Permit No: _Z_1- 0_6__ - --------'----------------------------------------------- s --------------------------------------------------------- This permit Expires 1 Year From Date Issued Date 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/L-OCAT NCS Asa = -"`''� CENSUS TRACT �r -----� ► -. Owner's Name9(�r Phone _.________ Address - --- � - City �J!'Z. �i u � Contractor's Name -----�'-`''v License # __� ... Phone ------------------------------ Installation will serve: Residence [/Apartment House❑ Commercial ❑Trdiler Court i❑ IMotel ❑ Other ------------------------------•------------- 4 Number of living units:------I----- Number of bedrooms --------Garbage Grinder ___________ Lot Size ----------------------___---___---__________ Water Supply: Public System and name ----------------------•---------•--------------------------------- --------------------------------------------Private In s Character of soil to a depth of 3 feet:; Sand'❑ -Silt❑ Clay E] Peat E] Sandy Loam ElClay,Loam E] Hardpan g Adobe-❑ Fill Material ----- If If yes,type ---------------------------- s (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 ifpublicsewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTICiTANK'[�,. - Size_-- i�_ X_ _f___ '__��.-_-____ Liquid Depth _4 ----._______-. _-_ Capacity -Oboe- Type - ------------------ Material_ ------ No. Compartments __19L � Distance tolnear st: Well ------_��_Q__ ________________Foundation ----,1_a__ _______ Prop. Line __ __�__ _____- (� LEACHING LINE ['� No. of Lines _______/__________:__ Length of each line__ ............ Total Length .__1_!1 ...... d 'D' Box —------- Type Filter Material ---25;�_k-------Depth ,.Filter Material ---fq__ ________________________________ s . Distance to nearest: Well ---------------------- Foundation ----------- Property Line __S__! SEEPAGE PIT ] Depth ---- ___ Diameter ___¢ _ __ Number --------------------------- Rock Filled Yes M No .0 Water Table Depth -------- ---ra---=-------------------------Rock Size __/� Distance to nearest: Well ________` _______________________Foundation -.1,9-------------- Prop. LiAl! ne ............. REPAIR/ADDITION(Prev. Sanitation Permit #!_____ ______________________________________ Date ---------------------------------- 4 Septic Tank (Specify Requirements) -------------------------- ------------------------------------------------------- ------------------------ Disposal Field (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------- --- Owner s B Title ---- ------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------ ----------- DATE ��_",�d__�._ .�------------ -------------------------- BUILDING PERMIT ISSUED ------------------ .--------_-----DATE ------------------------- - ------ ---------------------------- ------------------ ADDITIONALCOMMENTS -- --------------------------------------------- ------------------------------------------------------------------ ------------- --------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------/----Q-------'•----- --------- ------------------------------------ - -------------- ----------- Final Inspection b ____D .- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �