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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT b� Cy�tplete in Triplicate] Permit No: -____ __—------- `rteThis Permit Expires 1 Year Erom Date Issued 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. 5.49 and existing R-Leas�qnd Regulations. JOB ADDRESS/LOCATION --_` _____.. - ---__6,-43 -/-------49-7_J__---,W�US TRACT` -------------- ----------- Owner's Name w-1.467-1 1// -------------- ------------------------------ ------ -----Phone --- -- - -- -- - --- J Address ---- l Y----- ----7------- --------------- City _ =/�/j{1,31"ll----------------------------------------------------- Contractor's Name ----- _. _ - __ __ __________________License #-Z -.(397 4- Phon�_ -- /` _ Installation will serve: Residence ❑Apartment House❑ Commercial -❑Trailer Court 0 } Motel ❑Other -------------------------------------------- Number of living units:------------ Number of bedrooms ________Garbage Grinder ------------ Lot Size ____________ Water Supply: Public System and name ----------------------•----------------------------------------------------------------- ---------------------Private Character of soil to a depth of 3 feet: Sand�q Silt o Clay ❑ Peat ElSandy Loam ❑ Clay Loam i Hardpan ❑ Adobe ❑ Fill Material U13- 4f-yes,-type =:-„----------------- ---- -- 'F (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 f ] Size------------------------------------------------ Liquid Depth.__________..__--____ ___ - _ - Capacity -------------- --- Type -------------------- Material---------------------- No.. Compartments -----------------:- 2 iDistance to nearest: Well ____________________________________Foundation ____.________________-Prop. Line ____.___.-....:..___.-_ LEACHING LINE [ ] No.11of Lines -------------------- Length of each line---------------------------- Total Length ------------ ........ C� 'D' (Bo%__I_.__-__-- Type Filter Material -------------- ----Depth Filter Material -------------------------------------------- I Distance to nearest:`Well - ________________ Foundation ------------------------ Property Line. __________________-_____ Diameter Number ______________ Rock Filled Yes ❑ No SEEPAGE PIT [ ] Depth C1 Water Table Depth. ------------------------------------------------Rock Size -------------------------------- { Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---.----.-----------_. REPAIR/ADDITION(Prev. Sanitation Permit.# -------------------------------------------- Date ______.__________________________- i Septic Tank (Specify Requirements) ------------- - -- ----- - i - Disposal Field (Specify Requirem ts} _ )�p _ _ {' �_�-------------------- --------------------------------------- ------------------------- ---- - ------------- ----- = ---------- a (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. v "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 Wor anis Compensation laws of California.” Signed --- -- - ---'-'` = -----------------------v Owner ' BY 'F - ---- Title ----------------------- --------- --------------- -------------- ------ (If other than owner) 4 `FOR .DEPA:RTMENT USE ONLY oop� APPLICATION ACCEPTED BY ----- s_t�� r-_______ ___-__ DATE ----_` ___ ___Cr i BUILDING PERMIT ISSUED - --------------- ---------- - ------------ DATE ------------------------ ADDITIONAL COMMENTS - -----------------------------------------------------•---------------- --------------------------------------- -- ---- --------------- --- ----- - - - ---------------------------------------------------------------------------------------------------- ------------- -------------------- ---- ----- ----------- ------------------------------------------------------------------------ t _ _ € ---------------------------------------------------------- Final In E -------------------------------------------.Date ------ = �. SAN JOAQUIN LOCAL HEALTH DISTRICT � E. H. 9 1-'6B Rev, 5M