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FOR OFFICE USE: -APPLCATION FOR SANITATION PERMIT �qd _ Permit No. ��---5-'�•- _ _&JA----- _V! (Complete in Triplicate) q ---------- - Date IssuedR ------ ThisPermit Expires t Year From issue ------------------------------------------------------ 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: CENSUS TRACT -------------------------- JOB ADDRESS/LOCAT O -- - G ----- _ :_-�------------ --Phone Owner's Name �` _�� r «. ? CI -- Address---F--- �- --- . - . i • " - r ----License. # --- Phone Contractor's Name-- fi �'�`` "f t Installation will serve Residence ❑ Apartment House❑ Commercial frailer Court [] Motel-0 Other -------------------=----------------- r Number of living un ts:-_--------- Number of beclroomsy►_ _._ _-_-Garbage.Grinder ------------ Lot Sze Water Supply: y - `3 t------------------ Private Public System and name ----------------------- -------- - - ----" - ' peat Sand Loam,0 Clay Loam Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ ❑ Y E., . 'j, .� ifyes,type---------------------------- HardPan ❑ Adobe Fill Material --- (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 feefi,) {� j//� ` I Liquid Depth - ��-------------•- t PACKAGE TREATMENT C SEPTIC TANK�j'' Size--- -- �` q P -:� -- N,o'. Compartments Capacity 2- !! --- TYPe _ Material-�f�/1��`_ P �` ' �~ Distance to nearest: Well �� -- - - Foundation -- Prop. LineLength of each 'I%ne.---- '` - ----- r •v g Total- Length :---�-- - LEACHING LINE No. of Lines --------- -------------- (1 in p . D' Box _------_" - Type Filter Material '3- �_=.C--De th Filter Materia f Foundation - e- ----------- Property Line " ----`= --•--- Distance to nearest: Well ��f�---------�; ; { Number ----------------------- ,W _____---- - - } Rock Filled Yes No i❑ ----__--- Diameter --- SEEPAGE PITS t Depth _ -- —_ - f `��Rock Size . _; ! Water Table Depth ---- r S7 Distonce to nearest: Well/-—-------------•-------•- ` Foundation ------- Prop. Line - l ) - Date -------•-------•-- ------------- REPAIR/ADDITION(Prev, Sanitation Permit�# --------------------------- ------ ------l-t - ____j---------------------1------------------ ------- -------------------- Septic Tank (Specify Requirements _------------------------------- ------------------ a ---------------------- ---•--------- Disposal Field (Specify Requirements) ----------------------------------------- -------------------- -------------------------------------------- :. ---------------------------------------------- - (Draw existing and required additio� 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. SonJoaquinLocal Health District. Home owner or licen- sed agents signature certifies the following: y person in such manner "1 certify that in the performance of the work far which thus permit is isued, I shall not employ any f as to bye o+ a ;ubie. Wor man411 pensati.on la s"of California.'} rC -1 � weerO Signed :-dr y 1 Title ` --- -•C .ftp- -- ;�;--- ---- -------- ------ --- (If other tha owner) FOR .DEPARTMENT USE ONLY .�� r ------------- _ / r.b. DATE ----�'------- ---- -----� APPLICATION ACCEPTED BY ---- - -' ----- 7la--•a-"'--------------------------------------------- ------------------------ --------------- - ----------- BUILDING PERMIT ISSUED-:-__._ —____-. :--:__- == - DATE __ __ --------------- -------------------------------- ---— =--_ ADDITIONAL COMMENTS y� _ �., t------------------------------------------------- '' ---- ----'-=--- --� �� - ---- -=• '---------- ' = ---- I �..3 --- _--__-.--__-"-__-_-____"-__-"____________ - __ _---_ _ _ - _ --_ - __ -d � - Dafie-- ------------------------- - Final Inspection b ' --- ' ` • SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M ^-� ' ` ^-