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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - (Complete in Triplicate) Permit No. ��_-5��_ - - -------- T Date Issued _`. 4- -----____-____________-___--------_--__,r__:___- Als Permit Expires 1 Year From 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/LOCATION ._- - _ (/__------- Ii------, _ s_ t1_ -------CENSUS TRACT --------------•----------- Owner's Name ------/�•e-�--/ `t--------=�--------f�r 't Phone --------------------•-----------.. Address �a-11�i-- ' -------. itY Contractor's Name _ __ __ __ ______ ice se # --10_�- � __ Phone __________________..__........ Installation will server Residenc6XApartment House❑ Commercial :❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units----_ ------- Number of bedrooms _ __-_-_Garbage Grindera2 _ Lot Size -----io �P ... Water Supply: Public System and name ------------------------------------------------------------ ----------------------------------Private' Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy LoamA Clay Loam .E] 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,) PACKAGE TREATMENT [ I SEPTIC TANK'S Size__ __ ----------_------_------_------------ Liquid Depth ____________-__-._- Capacity -------- Type 06__ Material__. Compartments ----2,-_.......... \` Distance to nearest: Wel! ______ __ __________________Foundation __"w --------- Prop. Line --__..�_T..__..__ q LEACHING LINE [ ] No. of Lines __3 ----------------- Length of each line _.__.�<J----------- Total Length .--_2__ .r' r y `D' Box "-�Tl ype Filter Materia ____ -G__Dept Filter Material ______ �_____-"__________________________ Distance to nearest: Wel! ___,_,,IV......... Foundation ------ r ,_l___ Property Line __-.__ SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ----------------------------- Rock Filled Yes ❑ No Water Table Depth ------------------------------------------------Rock Size ----------------------------•--- Distance to nearest: Well ________________________________________Foundation ---.-----------.---- Prop. Line --------..____-___..__ REPAIR/ADDITION(Prey. Sanitation Permit# --------_--------_-------------------------- Date ________-_______________-_____---.) 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, I shall not employ any person in such manner as to bec me s=8cit- By to Workma=penso' ti.on laws of California." i Signed --- �4 Owner ------- -- --- ------------------------------------------ ------------------------- Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY aZ.--d-------------------------------------------- - DATE ------r�,�- �-� � (��-------- BUILDINGPERMIT ISSUED ---------------------------------------- ----------------------------------------------------------------DATE -------------- --------------------------- ADDITIONALCOMMENTS .--------------------------------------------------------------------------------------------------------------------------------- --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------•- ---- ---- - -- -------------------------------------------------------- ---- ------- ----------- --- Final Inspection by: ------ 0'E.� --------------------------------Date -9_23 --------- SAN JOAQUIN- LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M