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i FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT ---- ----------�.�-�`3-----,--------- ---- --- Permit No: (Complete in Triplicate) Date Issued This Permit Expires 'y 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. J CENSUS TRACT --------------...... JOB ADDRESS/LOCATION .------ '�_----� ---'�-=�-�----��.y+, ..✓---------- --- ----- ------- ----- ----- Owner's Name -_ /�} n L ISI/1� 1 --------------------------- -Phone -,Pc ' Address ---/.3-,2.7 ------- _ L� c5 ems.- --------------------------- City - Contractor's Name ------ ��..__r � -------------------Licenses/ Phone _ 6 Installation will serve: Residence T'Apartment House❑ Com ercial :❑Trailer Court i❑ Motel ❑ Other _.-`771 - .-_---- Number of bedrooms �__-___Garba a Grinder ------------ Lot Size X -C-------------------- Number of living units:__._ i1 -_- g Water Supply: Public System and name ---------------------------------••----------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam El Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ._______-.--__----_-__--:- {Plot plan, showing size of lot, II cation of system in relation to wells, buildings, etc. must be placed on reverse side.] I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size......... _7�c5 1.---------- Liquid Depth ________,____ .► o. Compartments f Ca acit i a_ . T e Material__�_.uz� P f P Y s- -- -- -- --- - YP � i Distance jto nearest. Well _-_ -----------------------Foundafiion __ v__________._ Prop, Line .-` _________.._.-_ 9 LEACHING LINE [ ] No. of Lines -._....Z------------ Length of each line---."7.4--------------- Total Length ._.f��-_-__-_-_-_.__ l}� 'D' Box _1--_.___.--_ Type Filter Material --- Depth Filter Material __/9 -------------------_____ Distance to nearest: Well ------------------------ Foundation --------------------- -- Property Line ------------.-----..-_-- SEEPAGE PIT [ ] Depth -1----------------- Diameter --------------- Number _.__._".__._____.___._."___ Rock Filled Yes ❑ No Water Table Depth ----------------------------Rock Size -------------------------------- -------------------- t -- �. Distance,to nearest: Well -------------------------------•--------Foundation ----------------_---- Prop. Line -------..•------__-- _ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _...._.---------------------------? Septic Tank (Specify Requirerr�nts) ------`----------- Disposal Field (Specify Requirements) ------------ ---------------- ------------------------------------------------------------------- P ----------------------------------------------------------------------------------------------------------------- --- ----------------- ------------------------------------------------ I ------- ---"---------------------------------------------------------- --------------------------------------- {Draw existing and required addition on reverse side} I hereby certify that I have prep ared 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 become subject to Workman's Compensation laws of California." Signed -- --- - - --------- - -----------4------------t------ Owner _ - - ------------------ - ---------------- ------------------------- � -------------------- - Title ------------ ---------- - {If other than owner) c� FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY -------- -1`------------------------------------------------------------------------------- --- DATE .... ------------------ BUILDING PERMIT ISSUED - -------------------- -------------- ------------ - -------------------------------------DATE ------------------------------------------- ------------ - -- - ADDITIONAL COMMENTS ---------t----------------- -- --------------------------- ---------------------------------------------------- -------------------------- -- ----------------- --------- ------- --------------------------------------------------•--------------------------------------------- k --------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ------------- --------------------------------------------- ---- --_-- Final Inspection b Date _ ____----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M