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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------f'------------------------ ----- Permit No. 4�4 Igo (Complete in Triplicate) ------------------------------------------------------------ This Permit Expires 1 Year From Date Issued' Date Issued �`�- 6.7 - 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.j549 ani existing°Rules and Regulations: 1 i F JOB ADDRESS/LOCATION ._TJ___,�L_ I��4-=__ _ �5 -1 .-------------`''�--.---CENSUS TRACT --------------.-------- Owner's Name -------------- ------ 6 ----- ------Phone _3_"3122-�� it Address ------------------------------------ City e?IAT� ---------------------------------------•---•--- Contractor•s Name ---------------------License Phone Installation will serve: Residence [A"X-partmen# House❑ Commercial ❑Trailer Court Motel ❑Other -------------------------------------------- F Number of living units:.-/------- Number of bedrooms •-3-------Garbage Grinder-'.I'�4___ Lot Size .... ------- ' ------- Water Supply: Public System and riame ------------------------------------ -------------------------------------------------------------- ------Private [ . Character of soil to a depth of 3 feet: Sand'(Silt❑ Clay ❑ Peat❑ Sandy Loam .0 Clay Loam 0 iHarcipan 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,) PACKAGE TREATMENT [ ] SEPTIC TANK'( ] Size________________________________________________ Liquid Depth .___--_________-.--_----- I ... .Capacity ----------------- Type -------------------- Material---------------------- No. Compartments ------------------••-- JaIaDistance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --------------------- LEACHING LINE [ ] No. of°Lines ------------------------ Length of each line------------------.--------- Total Length _______---________._._.- 'D' Box ------ Type Filter Material ____________________Depth Filter Material ------------------------------------------ Distance to ares#: Well ____ Foundation ____-----.----_________ Property Line ____----__-_______------ SEEPAGE PIT [ ] Depth ?� - --.-�---.--____-� Diameter ________________ Numberw-:_--------------------- -- Rock Filled Yes ❑ No .0 WaterTable Depth ------------------------------------------------Rock Size'-------------------------- Distance to}]nearest. Well -------------------------------------•--Foundation°-----------_-------- Prop. Line ...-------......... .:_ , I � { ~k REPAIR/ADDITION(Prev. Sanitation'Permit.#-----------.---=----'�----------------------- Date ------ --------------•------------) ------ - eu � �T Septic Tank (Specify Requirements) - ---------------- . E - -------------- -------- / _ Disposal Field (Specify Require`men#s) �� -..� �-- �' ------------------ �R�j�/ it d ,k.d'. •...-� -. ._.. =.r. ` 4(Draw existin and required addition on reverse side) I hereby certify that It,have prepared this application and that the work will lie 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 far.-which this permit is issued, I shalllnot employ any person in such manner i as to become subject to Workman's Compensation laws of California." Signe ------------------ F-- - ------ ------ --------------------------------------------------- Owner By --- < ------------------------------------------------- Titled� y� / � y `---------- f other tan-own IF < FOR DEPARTMENT USE ONLY � ---�; _ y - APPLICATION ACCEPTED BY ---- ! ------------ -------------------`7--------- �------- ------- DATE BUILDING PERMIT ISSUED ----------- = `` :,.._- �. ------DATE --------- --------------- --------- - . -- ADDITIONAL COMMENT ------ I---------------------t--`----------- -----------------____-`---------------------------•-------------------------------------------- ------- - , --' - .� ------------------------- ------ -------- -- -------- - = -- ---- ---- - 4w i --------------------------------- ------------------------------ Final 1 recti --------- -- -- - -- - ---------- ---------' -- -� Date .._. . . .� ...,.�, ,..� _. ...,.,SAN..,JO,AQUIN,.LOCAL,.HEALTH_DISTRICT.--!-- E. ISTRICT�� .. E. H. 9 1-'b8 Rev. 5M