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FOR OFFICE USE: APPLICATION FOR fANITATION PERMIT _ � Permit No. ...��'�6��_-. - - --- �-.5 -:� = (Corn�l'�,�Trip�pte) --------------------------- - -- -------'-- - Hate Issued /6___1--------- --_------------------ This 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 ----- E 1VD YCENSUS TRACT -------------------------- Owner's Name .. yy��,�,, ----- - --------Phone . 1:'_ -1------ Address ----------------------------- --- ------------------------------------------. City --•57 -t-A--/ 71:�I,--------------------------- ----------- Contractor's Name License # /%-��-- Phone { T` Installation will serve: ! Residence Apartment House❑ Commercial ❑Trailer Court ;❑ i Number of living units: Motel ❑ Other --------------_----------....__-__... .--_ g - Number of bedrooms c-.._-_.Garbage Grinder ��-- Lot Size -�/ - Water Supply: Public System and name -------------------------------------------- ----------------------------------------------------------------Private4 i 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,) PACKAGE TREATMENT I ] SEPTIC TANK![ ] Size------------------------------------------------ Liquid Depth -------------------------- Capacity -------------------- Type -------------------- Material---------------------- No. Compartments -----------------:---- Distance to nearest: Well ------------------------------------Foundation --------.--------_---- Prop. Line ------------.--------- V LEACHING LINE ( j No.• of Lines ------------------------ Length of each line---------------------------- Total Length ------------ ---------------- 'D' -----_--------------------- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------------------------- Distance to nearest: Well ------------------------ Foundation ----------------------- Property Line --._....._-__...------ SEEPAGE PIT [ ] Depth --- ---------------- Diameter ---------------- Number -... ----------------------- Rock Filled Yes ❑ No i❑ Water Table Depth --------------Rock Size --_----------------------------- , Distance to nearest: Well --------------------- ----- ----Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------------------=-------- Date --------- .-------------------) --- ----------------------------------- Septic Tank (Specify Requirements] _-------------- -------------- --- ------------------- --------- - Disposal Field (Specify Requirements) .._-P7/_7a?>C----- --------�] ----� �,�---fir-------------------- ------------------ --------- -- -------------- -------------------- ----------------- - ------------------ ------------- 1� ---- -------------------------------------------------------- -------------------------------------------- --------------------------------------------------------------------------------- ----------- y (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 becomIsu jectPanowner) n's Compensation laws of California." --------------- Owner Signed - -- --- ----------------------- ---------------- BY Title---. _. _(If a FOR DEPARTMENT USE ONLY C1--------- ------------------------------- DATE 1A------- -7 APPLICATION ACCEPTED 8Y _�-C -----111t) -- BUILDING PERMIT ISSUED _ --------------- ----DATE ------------------------ ------------------------------------------------- ADDITIONAL COMMENTS --------------------------------- ---------------- r -- ----------- ---------------------------- ---------------- 1. -- -- -- - -----------------= 61 Final Inspection by: - ---- - _ - p -------------`--1 Date . SAN JOAQUIN L AL HEALTH DISTRICT I E. H. 9 1-'6$ Rev. 5M