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FOR OFFICE USE: APPLICATION- FOR SANITATION PERMIT ------------------------- --------------- Permit No. .7J-`1D._9.---- -----�----- [Complete in Triplicate) - ------=-------------------- -------------------------- - Date Issued -------------------------- This Permit Expires 1 Year From Date Issued 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: // CENSUS TRACT ---------------- •-------- JOB ADDRESS/LOCATION . -1-- _ / ------ -- Owner's Name�y-l l��!�'- -/�-± �Pl'l.l -� ---------------------- Phone Address ----/ ---- 1 _l------ 1 � 1 1 �� .------------------------1. City M_4_/VyJ _47/ --------------- --- ------ Contractor's Name ____ f �/ -------------- ------------------------------------License # t.33- 4 - Phone kzo Installation will serve: Residence 0?Apartment House-F-1 Commercial :❑Trailer Court k❑ Motel ❑Other ------------------------------------------•- Number of living units:--_/_-_-. Number of bedrooms '____Garbage Grinder ------------ Lot Size 4A)_ 0�<--------------- Water Supply: Public System and name -------------------------- ____ __________ ____ Private [ ' Character of soil to a depth of 3 feet: Sand;g Silt.Ej Clay ❑ Peat❑ Sandy Loam ❑ —C"lay Clay Loam 0 Hardpan E] 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,) i PACKAGE TREATMENT [ .] SEPTIC TANK,[ ] Size------------------------------------------ ----- Liquid Depth --------------------,-•- Capacity ---------------.--- Type --- :---------: Material------------------ --- No. Compartments ------ ----•- -------- - ------- Distance to nearest: Well -----:----------- ------------------Foundatio --- ----------------- Prop. Line _------------_-:------ LEACHING LINE [ ] No. of Lines ------------------------ Length f each line-------- -- ------ Total Length ------------------.--------- 'D' Box ------------ Type Filter Material ____________________Depth Fi er Material t _ Foundation ------- ---------------- Property Line -----`-------- pisfiance to nearest: Well ___-__"'_____-_ __-___ ------- yes PIT [ ] Depth __ - _-__- Diameter: ______ _________ Number __.__-____ ----.----------- Rock Filled Yes Q No i[] Water Table Depth ----------------------- _Rock Siz -------------------------------- Distance to nearest: Well ______________ -----------Founda ion -------------------- Prop. Line _-________----_--._- REPAIR/ADDITION(Prev. Sanitation Permit# ---------------- ---- --------------------- Date ____ :-__ ) , Septic Tank (Specify Requirements) ---__--._. Disposal Field (Specify Requirements) --- ° + ------------------------------------------------------------------------------------ -------------------------------------------------------------------- ----------------------------- 1 ----------------------------------------------- ---------------------------- ------------- ------------------------ ------------------- -------------------------------------------------- --------- - # (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 "I certify that in the performance sof the work for which this permit is issued, I shall not employ any person in such manner as to become subje t to W rkman's Compensation laws of California." Signed -- ------------- - ----------------------- Owner itle = ---------: ----------------- I BY - t ---------------- ------------------- (If other than own FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ------ ----- _- --�- 1----- --- - ---------------------------------- DATE ------�y J��--------- BUILDING PERMIT ISSUED -------------- ----------- ---------------------------------- -------DATE ------------------------------------------- ADDITIONALCOMMENTS ----=----- ---- ----- ---------------------------------- + --------------- ---------------------------- ; ---------------------------------------------------- ---------------------------------------------------- J - �- r ------------•--------- - 4 -Date --- �-------------- Final Inspection b -------- ------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M