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4 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---`----------------------------------= Permit No_ 71- q 7i } --- ------ ----------------------------- - (Complete in Triplicate l 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 Mules and Regulations: i r _M"._ -._.-._CENSUS TRACT ______._ JOB ADDRESS/LOCATION .3/ 1—;_` •- ~ u - �y pp�� Owner's Name ....VQ_jAll tel !!___- � 0- -----------------------:----------------- --- --.Phone .-d_- f1 J �_ Address 40.1 / el -- ------ 40---------------------. City �i Z�� Contractor's Name ------- ------------------------------ --------------------------- License __ Phone ' Installation will serve: Residence [X Apartment House❑ Commercial :❑Trailer Court ;0 . Motel ❑ Other -------r-�----------------------------------- -- Number of Living units------ .... Number of bedrooms -------Garbage Grinder ------------ Lot Size _________________________________________ # /� - ___Private Wa#er Supply: Public System and name ---------- ---- - �'3'---- �_� -------- -----------------------------•--•--------- ❑ Character of soil to a depth of 3 feet; Sand'% 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 seepage pit permitted if public sewer is available within 200 feet,) V: PACKAGE TREATMENT I ] SEPTIC TANK[ ] Size___ / __ ___________ Liquid Depth ---------____. Capacity ------- Type OaCP_4:� Material.. `� No. Compartments Distance to nearest: Well _______ __________________Foundation ___ n_f_____ Prop. Line _--------------------- ' t LEACHING LINE [ ] No, of Liners -. ------------------ Length of each line----- 710------------- Total Length _ lfi ......... ! 'D' Box ------------ Type Filter Material ___,___ _ --- p �'�'�`"_ Depth Filter Material --��------------------------------------ ` Distance to nearest: Well -------b`�-r____.__ Foundation __.__l_4_�___-__-___ Property Line _5�_ _____ ' SEEPAGE PIT Depth ------- Diameter ________________ Number ______. -------------------- Rock Filled Yes ❑ No 0 Water Table Depth 3 --•--..Rock Size -�------------------------------ ; Distance toi n earest: Well --------------------------------------- - ---- Prop. Line --__------.._... `' fi ' -____-- --..Foundation ------------- ->--- REPAIR/ADDITION{Prev. Sanitotion,Permit# ________________________________ .Date ----------------------------------- Septic _______________ 'Septic Tank (Specify Requirements 1 ----= ------------- -------•--------------------- i � . Di os I Field (Specify Re uirements) ' -------- --- ------------ --------- ----- (Draw existing and{ required addition on reverse side) I hereby certify thtit-I have prepared this application and that the work will be done. in accordance with San Joaquin County Ordiinanres,-'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 p5�rsoa-in-such-,manner as to become subject to Workman's Compensation laws of California." y _ Signed t = `--------------------- Owner , i � BY _1 - Title --------- -- ----- ------------------------------------- (If other than owner) FAR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -._-- ___-- _-'- -- ----------` --. DATE ------ d---- �—___/------------- BUILDING PERMIT ISSUED ---------- ----------------------f --DATE --- --- ------------------------- ADDITIONALCOMMENTS - --------------------------------------=- --------------------------------------------------=----------------- --------- s ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- --------- --------------- ----- ------.------------ - - Final Inspection b [��'� Date r Y SAN JOAQUIN LOCAL HEALTH DISTRICT ' E. H. 9 1-'b8 Rev. 5M