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r FOR OFFICE USE: :F APPLICATION FOR SANITATION PERMIT E -- --- ------------------------------ ----------- I (Complete in Triplicate) Permit No- -------- ----- � --------------- This Permit Expires 1 Year From Date Issued trate Issued ,... S'- -v Application is hereby made to the San Joaquin Local Health District for a per to construct:.and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. 41. - - I - F...... — JOB ADDRESS/LOCATION ._I�?v?-,�--------,---�-'_:_----•�ll'�1`�------- �- -- - - - f}.-�/-------------CENSUS TRACT -------------- -------- -- Owner's Name ---�*1e5------------G' uTL. ---------------------------------------- ------------- -------------Phone Address ------!!�_WMk------------- -:- �------------------------------ -------- ------------------V City --Ti�iB=��- ------- ------------------------------- -------------- € Contractor's Name -/el�L=- ---- 5 1'1l ------- -------- ------License # --- Phone 4Y/__-_5.`r�-?�--- Installation will serve. Residence Z.Apartment House°❑ Commercial ❑Trailer Court s❑ Motel ❑Other -------------------------- ----------------- i Number of living units:---- Number of_bedrooms __,Z-------Garbage Grinder 2-16-a------ Lot Size ----------------- Water Supply: Public System and name ----------------------- -------------------------------- -------------------------------------------------------Private IR Character of soil to a depth of.3jeet: Sand'M Silt.❑,. Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan❑- Adobe'❑ - Fill Materials=---� Ifyes;-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'{ jLiquid Depth __________________________ O Size---------------------------------------- Ca acit _ T e ____________________ Material--------------------.- No. Compartments Distance to nearest: Well ------------------------------------Foundation _.--------------------.Prop. Line --- ---------:-------- W LEACHING LINE [ ) No. of Lines ____ -------------------- Length of each line--------.------------------ Total Length ----------- ---------------- 'D' Box --I--_-_--- Type Filter Material --------------------Depth Filter!Material ----------------------------- ------ Distance to nearest: Well ___`___________________ Foundation Property Line, SEEPAGE PIT [ ] Depth ------------_------- Diameter ---------------- Number --------- ------------------ Rock Filled Yes ❑ No 0 WaterTable Depth ------------------------------------------------Rock Size -------------------------------- � 3 Distance to nearest: Well ----------------------------------------Foundation ------------------ Prop. Line -.-----------.-------. ` REPAIR DDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------.-----------------------) 1 - Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------:--------------------------------------------- 1 Disposal Field {Specify Requirements) __D_—_6_49X------- --� . 1� ------------------------ -------------------------- ------- ---- ------------------------------------------------ _ 1 ----- -- ---- -- --- - - - -- ---------- ----- :.: - _. (Draw existing and required additi' on-on r6v_e_se 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: E "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 subje to Workman's Compensation laws of California." Signed -------------e9;` ----------- --------------------------------------------- Owner BY -------------------------------------------------------------- - -------------------------------------- Title ------ ----- -------- ------------------------------- -------- (If other than owner) FOR DEPARTMENT US LY APPLICATION ACCEPTED BY ------------- ----------------- = DATE -----c� 71.2 p. --------------- BUILDING PERMIT ISSUED --- --------� --------------- ------------- -----DATE -- ADDITIONAL COMMENTS ------------------------------------- ----------- t ------------------------------------------------------- - --------- -------------------------------------------------------------------------------------------- ---------------- _,roD = Final Inspection by ----------------------- ---- Date --------------- r SAN JOAQUIN LOCAL HEALTH D TRICT E. H. 9' 1-'b8 Rev. 5M.