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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �j 33 ---------------------- -------------- ---- -- Permit No. __ `_ .l_ (iComplete in Triplicate) - ----------------------------------------------- 7- --- This Permit Expires 1 Year From Date Issued Date Issued r 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/LOC ION _1V16:Y_Z----3-------�_W CENSUS TRACT ------- " Owner's Name ----i�op-F\i_----------rA L.0 --- `` Phone Address --------16 6 Y2 ------ -------------- City --------------------------------•---------------------------------•--------- Contractor's Name ...... YLINi-E[Z..------=;;--------- ------------ ----------------------License # ---------------------- Phone -------------------------_- Installation will serve: Residence Apartment House Commercial ❑Trailer Court Motel ❑ Other ------------------------------------------ Number of living units:____ ----- Number of bedrooms 3-------Garbage Grinde -- Lot Size _ CHUG =- -....- -- Water Supply: Public System and name -------------------------------__---------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan 0 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.) s NEW INSTALLATION:" {No peptic tank or seepage pit permitted if public sewer is avai ble within 200 feet,j PACKAGE TREATMENT t ] SEPTIC TANK'[e] Size------------------------------------- -- ------ Liquid Depth ---------------------.----- ,.. Capacity -------------------- yPe -------------------- Material r`;------------- No. Compartments ---------•------------- F - -Distance to nearest: ells: --------------------•-----=_-= Foundation --- ------------------ Prop. Line ----------------------6 LEACHING LINE [ ] No. of Lines =__.________ __..----- Length of each lin-e' -:-.1--------------- _F __ Total Length ---------------------------- 'D' __-_____-_--- .--_ _ ____--'D' Box ----- ------ Type ilter SMaterial ____________________Depth Filter aterial ____.________-____________--..__________-- Distance to nearest: W II`-_--------------------- Foundation --------------- ________ Property Line ____---.__________...__. SEEPAGE PIT [ ] Depth ____________________ Di meter ___________-__ Number --Rock Filled Yes ❑ No ❑ Water Table-Depth ----- ------------------------------------------Rock Size ---- ----------- Distance to nearest: W _ _____________________________________Foundation -------------- Prop. Line __________. --..._.__ REPAIR/ADDITION(Prev. Sanitation Permit# ___ _ ------------------------------------ Date -------------- _ --_____________.-] Septic Tank (Specify Requirements) --------------- -- -------------------------------------- --------------�---------------------..-,------------------------------------ Ib Disposal Field (Specify Requirements] ---.f�/S_T___ 0�5,------------- ---------- � ------ sal Field ------------ - ------ PIS- --------------------- --- --- -- -----------------------:------------------------------ --------- (Draw existing and required addition on reverse side). T - 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 age signature certifies the f awing: "I certif t at in, n hethe work for which this permit is issued, I shall not employ any person in such manner as to be o e bjec to orkm s Compensation laws of California." Signed -- -- ------ �---------------------------------- Owner By ----"------------------------------------------------------------------------------nut�-`Zp----- Title ------ -------------------------------------------------- -------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------f ;-R-,Oc----------------------------------------------- -----------. DATE ----_��-_�t tj------- BUILDING PERMIT ISSUED -------- - ----------------------------------------------- ----DATE -------- -------------------------- ---------------------------------- ADDITIONAL COMMENTS ___ _ __ - _ " - - _- --- --- ------- ----------------------------------------- --------- - ------------ =--=- --- ''' ------------------- _ _ ---------- ----------------------- --------------------- -- --- - --------- ------- ------ ---- -------- ---------------------------------------------- - �-Z—� Final Inspec ---------Date -- ---- ---------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M