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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --------------- {Complete in Triplicate} ---------=----------------------------------------------- This Permit Expires 1 Year From 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. 549 and existing Rules and Regulations: / � -• w CENSUS TRACT ------------- -----•----- JOB ADDRESS/LOCATION '.-__---------------------------- - Owner's Name _-/ - --- - e ---- �rf�'---.�' __Phone 7 aa�� / �! _ D _ Address �.6—__6 6 fG-----a7- ` 444 -- O--'- ----------------------------•--•--- City r --------------- /� l j� 1 Phone �C -c5 Y Contractor's Name _ c�'I�. 9�- - -f License Installation will serve: Residence ❑Apartment House❑ Commerciin al:❑Trailer Court '❑ Motel ❑Other ---0_ 1 - ----------------- 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'❑ Silt L7 Clay .❑ Peat ❑ Sandy Loalm ❑ 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.) 5 � r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is.ovailable within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------------•---------------- -- --- Capacity -- Liquid Depth ____--__--- Ca acit - Material______----_____ No. Compartments __________________ __ P Y ------ ------------- Type P Distance to nearest: Well ------ ----------------------------Foundatio ---------------------- Prop. Line -- ------ Ln ------------------ - -777 LEACHING LINE [ ] No. of Lines ----------------------- L gth of each line-_-------------- ---------- Total Length A------------------------- .. „. { # Depth Fil er Material -----------------------------• 'D' Box ------------ Type Filter Ma enal --------- -•------ - P -------•----••--- 4 Distance to nearest: Well -------- --------------- Foundation '_____R .___ --- Property Line.,-_----------------- ---- ' SEEPAGE PIT [ ] Depth ---__________ _---- Diameter Number -._�------ ------------ -- Rock FilledF''Yes�❑ No ------------- Water Table Depth --------------- -----------•- ------- ------ --Rock Si `----- n. Distance to nearest: Well ------ --------------------------------Found ion -------------------- Prop:.Line ..-----------_----� REPAIR/ADDITION(Prev. Sanitation Permit# -------- - - ------------------------------ Date -- ------------------------------) ------------------ ----------.-------------------------- Septic Tank (Specify Requirements) ---------------------------------------------------------- t Dis osal Field (Specify Requirements) 1/V �f-____fY-�_4v____-s ?d-- `-----��j�' '` -�&.W�&------ --------------- E P P Y q • - - - - -- - -- .�} 4-rvd-------eo--- '--•t e �_�. -�'rv� e �vc� - 7%_ _ r._f `�(�-lid `�' --�-�-��----- pxlsS�I 9-'------ '��`c' ��?wf'4�__ --; ; 4 (Draw existing and required addition-on-reverse side) ff a 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: o�r "I certify that in the performance of the work for which this permit isassued, I shall not. employ any person}in such manner as to become subject to Workman's Compensation laws of California." t` �= I Signed --- --------r------ Owner J � --------------------------- g r Title _ --f---�- ---- ------------------- Y tr (If other than owner) , 7 ¢` r' .�. FOR DEPARTMENT'USE ONLY C. } 4 ; APPLICATION ACCEPTED B -------------- ��C� 77rn-- ------------ --- DATE T / 1r- 7/ BUILDING PERMIT ISSUED - ------- - ------- -------------------------- - -------DATE -----------•----------- ----------------- ADDITIONAL COMMENTS -------------------------- --------- F -------------- E--------- ----------------------------------I-------------------- ------- - -------------------------------------------------------------------- -------------------------------- ________________________________________ _ _____.____._---______-_______--_____-_ _____________________________ ____________ __________ -------------------------------------- -- ___ _ __ _ ___ _._____ ____ _ __ ________µ_ __________________________________________________ ------------------________ Final Inspection ------ --- ----- ------ --------- --- `£------------.Date -- -- Y_� SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'b8 Rev. 5M